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General NPI Number Information
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NPI Number | 1689182412
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Entity Type | Organization
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Legal Business Name | SAVERITT PEDIATRICS PLLC
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Dates
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Enumeration Date | 01/15/2018
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 5501 WILLOW CREEK DR STE 203
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City | SPRINGDALE
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State | AR
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Zip | 72762-8708
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Country | US
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Telephone | 479-575-9359
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Fax |
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Provider Business Mailing Address
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Address Line | 2857 N DORCHESTER DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-3989
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Country | US
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Telephone | 479-236-7974
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. SUSAN M AVERITT
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Credential | MD
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Telephone | 479-236-7974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | E2459
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License Number State | AR
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