# TILLEY FAMILY MEDICINE, PA

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

## Provider details

- **NPI number:** 1679581730
- **Authorized official:** BRENDA LEIGH STONE (OFFICE MANAGER)
- **Authorized official phone:** (501) 327-1150

## Contact information

- **Practice address:** 495 HOGAN LN, SUITE 1, CONWAY, AR 72034-8201
- **Practice address phone:** (501) 327-1150
- **Practice address fax:** (501) 327-3427
- **Mailing address:** 495 HOGAN LN, SUITE 1, CONWAY, AR 72034-8201
- **Mailing address phone:** (501) 327-1150
- **Mailing address fax:** (501) 327-3427

## Taxonomy

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

## Other

- **Enumeration date:** 08/04/2006
- **Last updated:** 09/14/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 134809002 | — | AR |