Provider Demographics
NPI:1588684492
Name:EUBANKS, CHENIA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:CHENIA
Middle Name:Y
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 CHILDRENS WAY # 653
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1000
Mailing Address - Fax:501-364-6582
Practice Address - Street 1:9015 DAILEY DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209
Practice Address - Country:US
Practice Address - Phone:501-364-6560
Practice Address - Fax:501-364-6582
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-11474208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011001570002Medicaid
PAH28378Medicare UPIN