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General NPI Number Information
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NPI Number | 1245116367
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Entity Type | Organization
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Legal Business Name | CLINIC ON MAIN
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 924 MAIN ST STE A
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City | LITTLE ROCK
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State | AR
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Zip | 72202-3818
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Country | US
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Telephone | 501-319-7074
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Fax | 501-246-3343
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Provider Business Mailing Address
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Address Line | 1423 SUTTON MEADOW LN
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City | CORDOVA
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State | TN
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Zip | 38016-7631
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Country | US
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Telephone | 901-214-7835
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Fax |
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | ARTHURENE WILLIAMS
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Credential |
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Telephone | 901-214-7835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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