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General NPI Number Information
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NPI Number | 1578909362
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Entity Type | Organization
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Legal Business Name | DYSON PSYCHIACTRIC CARE, LLC
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 05/23/2013
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Provider Practice Location Address
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Address Line | 820 E MATTHEWS AVE
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City | JONESBORO
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State | AR
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Zip | 72401-3048
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Country | US
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Telephone | 870-972-1497
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Fax | 866-422-5771
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Provider Business Mailing Address
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Address Line | PO BOX 17253
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City | JONESBORO
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State | AR
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Zip | 72403-6723
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Country | US
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Telephone | 870-972-1497
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Fax | 866-422-5771
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CORI ANNE DYSON
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Credential | M.D
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Telephone | 870-972-1497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | E-5305
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License Number State | AR
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