Organization
CLARKSVILLE MEDICAL GROUP, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALI GRAVES CPCO (PRACTICE ADMINISTRATOR)
(479) 754-0804
Entity
Organization
Contact information
Practice address
601 W MCKENNON ST, CLARKSVILLE, AR 72830-3523
(479) 754-8384
(479) 754-7141
Mailing address
PO BOX 668, CLARKSVILLE, AR 72830-0668
(479) 754-8384
(479) 754-7141
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MC-0283
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103094002
—
AR
01
—
56716
BLUE CROSS BLUE SHEILD
AR
Enumeration date
05/31/2005
Last updated
06/26/2025
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