# CLARKSVILLE MEDICAL GROUP, P.A.

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

## Provider details

- **NPI number:** 1447253810
- **Authorized official:** MRS. ALI GRAVES CPCO (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (479) 754-0804

## Contact information

- **Practice address:** 601 W MCKENNON ST, CLARKSVILLE, AR 72830-3523
- **Practice address phone:** (479) 754-8384
- **Practice address fax:** (479) 754-7141
- **Mailing address:** PO BOX 668, CLARKSVILLE, AR 72830-0668
- **Mailing address phone:** (479) 754-8384
- **Mailing address fax:** (479) 754-7141

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MC-0283 | AR | Yes |

## Other

- **Enumeration date:** 05/31/2005
- **Last updated:** 06/26/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 103094002 | — | AR |
| 01 | — | 56716 | BLUE CROSS BLUE SHEILD | AR |