Provider Demographics
NPI:1245605278
Name:FAMILY PHYSICIANS OF JONESBORO
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS OF JONESBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-932-2499
Mailing Address - Street 1:3104 APACHE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7405
Mailing Address - Country:US
Mailing Address - Phone:870-932-2499
Mailing Address - Fax:
Practice Address - Street 1:3104 APACHE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7405
Practice Address - Country:US
Practice Address - Phone:870-932-2499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103146001Medicaid
ARC5926OtherAR LICENSE
ARAM9683118OtherDEA
AR103146001Medicaid