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General NPI Number Information
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NPI Number | 1831582758
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Entity Type | Organization
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Legal Business Name | MID- SOUTH RHEUMATOLOGY & INTERNAL MEDICINE
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 612 RIVER OAKS DR
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City | MARION
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State | AR
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Zip | 72364-9048
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Country | US
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Telephone | 901-833-2720
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Fax |
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Provider Business Mailing Address
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Address Line | 612 RIVER OAKS DR
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City | MARION
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State | AR
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Zip | 72364-9048
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | CHURCHILL AROBONOSEN AKHIGBE
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Credential |
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Telephone | 901-833-2720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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