Provider Demographics
NPI:1972569382
Name:BILLINGSLEY, JOHN A III (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:BILLINGSLEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2783 N. SHILOH DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6983
Mailing Address - Country:US
Mailing Address - Phone:479-442-8653
Mailing Address - Fax:479-442-2678
Practice Address - Street 1:2783 N. SHILOH DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-6983
Practice Address - Country:US
Practice Address - Phone:479-442-8653
Practice Address - Fax:479-442-2678
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0342174400000X
KS04-44501207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201327070AMedicaid
AR127773001Medicaid
AR5J702Medicare ID - Type Unspecified