Provider Demographics
NPI:1659389278
Name:LEE A. DAVIS, JR, MD, PA
Entity Type:Organization
Organization Name:LEE A. DAVIS, JR, MD, PA
Other - Org Name:HEARTCARE CLINIC OF THE SOUTH
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:870-850-0800
Mailing Address - Street 1:7500 DOLLARWAY RD STE 301
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-3084
Mailing Address - Country:US
Mailing Address - Phone:870-850-0800
Mailing Address - Fax:870-850-0801
Practice Address - Street 1:7500 DOLLARWAY RD STE 301
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-3084
Practice Address - Country:US
Practice Address - Phone:870-850-0800
Practice Address - Fax:870-850-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2239207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C879OtherBLUE CROSS CLINIC
AR150107002Medicaid