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General NPI Number Information
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NPI Number | 1770932550
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Entity Type | Organization
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Legal Business Name | SILLS DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 06/12/2016
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 1003 WINDOVER RD
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City | JONESBORO
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State | AR
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Zip | 72401-6007
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Country | US
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Telephone | 870-336-1600
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Fax | 870-336-0585
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Provider Business Mailing Address
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Address Line | PO BOX 16788
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City | JONESBORO
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State | AR
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Zip | 72403-6712
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Country | US
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Telephone | 870-336-1600
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Fax | 870-336-0585
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | ADAM ASHLEY SILLS
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Credential | M.D.
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Telephone | 870-336-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | E-4809
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License Number State | AR
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