Organization
BENTON PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY JEWELL ATKINS M.D. (PHYSICIAN)
(501) 315-0421
Entity
Organization
Contact information
Practice address
115 MCNEIL ST, BENTON, AR 72015-3345
(501) 315-0421
(501) 778-6312
Mailing address
115 MCNEIL ST, BENTON, AR 72015-3345
(501) 315-0421
(501) 778-6312
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
R2391
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50143
BLUE CROSS
AR
Enumeration date
07/07/2005
Last updated
08/22/2020
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