# FAIR PARK MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fair Park Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740481191
- **Authorized official:** DR. CARL LYNN JOHNSON M.D. (OWNER)
- **Authorized official phone:** (501) 663-6262

## Contact information

- **Practice address:** 5320 W 12TH ST, LITTLE ROCK, AR 72204-1859
- **Practice address phone:** (501) 663-6262
- **Practice address fax:** (501) 663-3189
- **Mailing address:** 5320 W. 12TH STREET, LITTLE ROCK, AR 72206
- **Mailing address phone:** (501) 663-6262
- **Mailing address fax:** (501) 663-3189

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | MC2208 | AR | Yes |

## Other

- **Enumeration date:** 05/31/2007
- **Last updated:** 08/22/2020