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General NPI Number Information
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NPI Number | 1871013367
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Entity Type | Organization
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Legal Business Name | SHILOH HEALTH AND LONGEVITY
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1794 E JOYCE BLVD STE 1
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5257
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Country | US
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Telephone | 479-443-7771
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Fax |
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Provider Business Mailing Address
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Address Line | 1794 E JOYCE BLVD STE 1
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5257
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Country | US
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Telephone | 479-443-7771
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. H. DANIEL ATWOOD
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Credential | MD
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Telephone | 479-443-7771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | R-3739
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License Number State | AR
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