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General NPI Number Information
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NPI Number | 1275808735
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Entity Type | Organization
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Legal Business Name | MALIYAH INVESTMENTS LLC
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Dates
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Enumeration Date | 03/16/2012
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 1000 E MATTHEWS AVE STE B
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City | JONESBORO
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State | AR
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Zip | 72401-4344
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Country | US
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Telephone | 870-336-4050
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Fax | 870-336-4059
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Provider Business Mailing Address
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Address Line | 1000 E MATTHEWS AVE STE B
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City | JONESBORO
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State | AR
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Zip | 72401-4344
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Country | US
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Telephone | 870-336-4050
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Fax | 870-336-4059
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Authorized Official
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Title or Position | PHYSICIAN, OWNER
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Name | DR. DARON MERRYMAN
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Credential | M.D.
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Telephone | 501-944-4802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E3920
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License Number State | AR
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