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General NPI Number Information
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NPI Number | 1821160151
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Entity Type | Individual
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Provider Name | SARA ELSIE GRAMLING VAN SCOY MD
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Gender | Female
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 2239 S CARAWAY RD STE M
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City | JONESBORO
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State | AR
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Zip | 72401-6234
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Country | US
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Telephone | 870-910-3757
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Fax | 870-910-4999
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Provider Business Mailing Address
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Address Line | 1600 ALDERSGATE RD STE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6676
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Country | US
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Telephone | 501-661-0720
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Fax | 501-325-7938
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | E-1043
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License Number State | AR
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