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General NPI Number Information
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NPI Number | 1548230550
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Entity Type | Individual
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Provider Name | GRAHAM MACK REID M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 10816 EXECUTIVE CENTER DR SUITE 101
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City | LITTLE ROCK
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State | AR
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Zip | 72211-4384
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Country | US
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Telephone | 501-221-3331
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Fax | 501-221-3339
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Provider Business Mailing Address
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Address Line | 10816 EXECUTIVE CENTER DR SUITE 101
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City | LITTLE ROCK
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State | AR
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Zip | 72211-4384
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Country | US
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Telephone | 501-221-3331
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Fax | 501-221-3339
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | C-5446
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License Number State | AR
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