# DICKSON STREET CLINIC

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

## Provider details

- **NPI number:** 1427236926
- **Authorized official:** DR. CARL R MAGNESS MD (OWNER/PHYSICIAN)
- **Authorized official phone:** (479) 521-1114

## Contact information

- **Practice address:** 102 W DICKSON ST, FAYETTEVILLE, AR 72701-5219
- **Practice address phone:** (479) 521-1114
- **Practice address fax:** (479) 521-2540
- **Mailing address:** 102 W DICKSON ST, FAYETTEVILLE, AR 72701-5219
- **Mailing address phone:** (479) 521-1114
- **Mailing address fax:** (479) 521-2540

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | C4954 | AR | Yes |

## Other

- **Enumeration date:** 02/06/2008
- **Last updated:** 02/06/2008