Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | C-5903 | AR |
N | 111NI0900X | Internist | C-5903 | AR |
Y | 207R00000X | Internist | C-5953 | AR |
Y | 111NI0900X | Internist | C-5953 | AR |
N | 207RA0401X | Internist - Addiction Medicine | C-5953 | AR |
NPI | 1861438665 |
---|---|
Provider Name | Dr. Thomas W Atkinson |
First Address | Fayetteville, AR 72703-0030 |
Second Address | Fayetteville, AR 72703-6214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 03/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110911001 | (05) | AR |
13075000001 | QUALCHOICE QCA (01) | AR |
238882 | VALUE OPTIONS PROVIDER ID (01) | AR |
50083 | BLUE CROSS (01) | AR |
B89908 | (02) | AR |