Provider Demographics
NPI:1356537666
Name:J. MICHAEL CARNEY, MD, PLLC
Entity type:Organization
Organization Name:J. MICHAEL CARNEY, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELVISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-455-4700
Mailing Address - Street 1:11321 INTERSTATE 30
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-7040
Mailing Address - Country:US
Mailing Address - Phone:501-455-4700
Mailing Address - Fax:501-455-9044
Practice Address - Street 1:11321 INTERSTATE 30
Practice Address - Street 2:SUITE 201
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-7040
Practice Address - Country:US
Practice Address - Phone:501-455-4700
Practice Address - Fax:501-455-9044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN7400207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty