Organization
HARRISON FAMILY PRACTICE CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAHLON OGDEN MARIS M.D. (OWNER)
(870) 741-8247
Entity
Organization
Contact information
Practice address
715 W SHERMAN AVE, SUITE G, HARRISON, AR 72601-2743
(870) 741-8247
(870) 741-3933
Mailing address
PO BOX 1597, HARRISON, AR 72602-1597
(870) 741-8247
(870) 741-3933
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101276002
—
AR
01
—
1028
HEALTH SOURCE
AR
Enumeration date
02/23/2006
Last updated
08/22/2020
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