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General NPI Number Information
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NPI Number | 1144628983
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Entity Type | Organization
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Legal Business Name | KJ MEDICAL MANAGEMENT
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Dates
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Enumeration Date | 12/10/2014
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Last Update Date | 12/10/2014
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Provider Practice Location Address
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Address Line | 11215 HERMITAGE RD STE 201
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3809
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Country | US
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Telephone | 501-414-8218
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Fax |
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Provider Business Mailing Address
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Address Line | 11215 HERMITAGE RD STE 201
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3809
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHN C WARE
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Credential |
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Telephone | 501-414-8218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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