Provider Demographics
NPI:1003671777
Name:MUMFORD AND ASSOCIATES
Entity Type:Organization
Organization Name:MUMFORD AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:QUINYATTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUMFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH
Authorized Official - Phone:501-229-9220
Mailing Address - Street 1:8 JORDAN MNR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-7902
Mailing Address - Country:US
Mailing Address - Phone:501-229-9220
Mailing Address - Fax:
Practice Address - Street 1:8 JORDAN MNR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-7902
Practice Address - Country:US
Practice Address - Phone:501-229-9220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health