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General NPI Number Information
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NPI Number | 1205467123
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Entity Type | Organization
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Legal Business Name | SPARTAN HEALTH & FITNESS
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Dates
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Enumeration Date | 01/29/2020
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2007 E NETTLETON AVE STE B
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City | JONESBORO
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State | AR
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Zip | 72401-5286
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Country | US
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Telephone | 870-520-5013
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Fax |
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Provider Business Mailing Address
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Address Line | 3028 COUNTY ROAD 751
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City | JONESBORO
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State | AR
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Zip | 72405-6811
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Country | US
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Telephone | 479-799-5520
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. BRADFORD W STEWART
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Credential | MD
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Telephone | 479-799-5520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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