# HARRISON FAMILY PRACTICE CLINIC, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093781825
- **Authorized official:** MAHLON OGDEN MARIS M.D. (OWNER)
- **Authorized official phone:** (870) 741-8247

## Contact information

- **Practice address:** 715 W SHERMAN AVE, SUITE G, HARRISON, AR 72601-2743
- **Practice address phone:** (870) 741-8247
- **Practice address fax:** (870) 741-3933
- **Mailing address:** PO BOX 1597, HARRISON, AR 72602-1597
- **Mailing address phone:** (870) 741-8247
- **Mailing address fax:** (870) 741-3933

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/23/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 101276002 | — | AR |
| 01 | — | 1028 | HEALTH SOURCE | AR |