Provider Demographics
NPI:1821788530
Name:OZARKS NEUROLOGY
Entity Type:Organization
Organization Name:OZARKS NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:THRESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-320-4818
Mailing Address - Street 1:4083 N SHILOH DR STE 9
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5201
Mailing Address - Country:US
Mailing Address - Phone:479-439-1696
Mailing Address - Fax:479-439-1998
Practice Address - Street 1:4083 N SHILOH DR STE 9
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5201
Practice Address - Country:US
Practice Address - Phone:479-439-1696
Practice Address - Fax:479-439-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty