# FAYETTEVILLE VAMC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** FAYETTEVILLE VA MOBILE CLINIC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063291961
- **Authorized official:** ERIN DENISE POTTER (NPI TEAM)
- **Authorized official phone:** (202) 382-2579

## Contact information

- **Practice address:** 1100 N COLLEGE AVE, FAYETTEVILLE, AR 72703-1944
- **Practice address phone:** (615) 355-3451
- **Mailing address:** PO BOX 94494, CLEVELAND, OH 44101
- **Mailing address phone:** (615) 355-3451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QV0200X | VA Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/28/2023
- **Last updated:** 09/28/2023