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General NPI Number Information
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NPI Number | 1821788530
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Entity Type | Organization
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Legal Business Name | OZARKS NEUROLOGY
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 4083 N SHILOH DR STE 9
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5201
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Country | US
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Telephone | 479-439-1696
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Fax | 479-439-1998
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Provider Business Mailing Address
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Address Line | 4083 N SHILOH DR STE 9
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5201
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Country | US
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Telephone | 479-439-1696
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Fax | 479-439-1998
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | THRESA CLEMONS
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Credential |
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Telephone | 501-320-4818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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