Provider Demographics
NPI:1598394405
Name:DELOACH, ABIGAIL LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LEIGH
Last Name:DELOACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6508 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CAMMACK VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72207-2707
Mailing Address - Country:US
Mailing Address - Phone:501-773-0005
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 520
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-773-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program