Organization
DICKSON STREET CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL R MAGNESS MD (OWNER/PHYSICIAN)
(479) 521-1114
Entity
Organization
Contact information
Practice address
102 W DICKSON ST, FAYETTEVILLE, AR 72701-5219
(479) 521-1114
(479) 521-2540
Mailing address
102 W DICKSON ST, FAYETTEVILLE, AR 72701-5219
(479) 521-1114
(479) 521-2540
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
C4954
AR
Other
Enumeration date
02/06/2008
Last updated
02/06/2008
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