Provider Demographics
NPI:1043788045
Name:ARKANSAS WELLNESS ASSOCIATES LLC
Entity Type:Organization
Organization Name:ARKANSAS WELLNESS ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-410-3800
Mailing Address - Street 1:1920 EAST STATE HIGHWAY 114
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:817-410-3800
Mailing Address - Fax:817-410-6466
Practice Address - Street 1:10700 N RODNEY PARHAM ROAD, SUITE C11
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212
Practice Address - Country:US
Practice Address - Phone:501-414-0438
Practice Address - Fax:501-414-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty