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NPI Code Detail

MEDICARE: CLARKSVILLE MEDICAL GROUP, P.A.

MEDICARE: CLARKSVILLE MEDICAL GROUP, P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMC-0283AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
256716OTHERARBLUE CROSS BLUE SHEILD

General Provider Information

NPI Number : 1447253810
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLARKSVILLE MEDICAL GROUP, P.A.
Provider Business Mailing Address
First Line : PO BOX 668
Second Line :
City : CLARKSVILLE
State : AR
Zip : 72830-0668
Country : US
Telephone Number : 479-754-8384
Fax Number : 479-754-7141
Provider Business Practice Location Address
First Line : 601 W MCKENNON ST
Second Line :
City : CLARKSVILLE
State : AR
Zip : 72830-3523
Country : US
Telephone Number : 479-754-8384
Fax Number : 479-754-7141
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : MRS. ALI GRAVES
Credential : CPCO
Telephone Number : 479-754-0804
Provider Enumeration Date : 05/31/2005
Last Update Date : 06/26/2025

Similar Medicare Providers

1245200971 — DR. KIM GRAVES M.D.
Practice Location Address:
601 W MCKENNON ST
CLARKSVILLE, AR
72830-3523
Practice Phone: 479-754-8384
Practice Fax: 479-754-7141
1083684740 — SUSAN GATELEY A.P.N.
Practice Location Address:
601 W MCKENNON ST
CLARKSVILLE, AR
72830-3523
Practice Phone: 479-754-8384
Practice Fax: 479-754-7141
1770553448 — DR. LINDSEY J PREWITT M.D.
Practice Location Address:
601 W MCKENNON ST
CLARKSVILLE, AR
72830-3523
Practice Phone: 479-754-8384
Practice Fax: 479-754-7141
1487624896 — DR. JOHN C DUNHAM M.D.
Practice Location Address:
601 W MCKENNON ST
CLARKSVILLE, AR
72830-3523
Practice Phone: 479-754-8384
Practice Fax: 479-754-7141
1174593446 — DR. MARY JANELL BURCH M.D.
Practice Location Address:
601 W MCKENNON ST
CLARKSVILLE, AR
72830-3523
Practice Phone: 479-754-8384
Practice Fax: 479-754-7141
1164482162 — JAMES BRIAN COTNER MD
Practice Location Address:
601 W MCKENNON ST
CLARKSVILLE, AR
72830-3523
Practice Phone: 479-754-8384
Practice Fax: 479-754-7141

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