Organization
AUTUMN ROAD FAMILY PRACTICE, P.A,
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN DRENNAN (ADMINISTRATOR)
(501) 626-7515
Entity
Organization
Contact information
Practice address
904 AUTUMN RD, SUITE 200, LITTLE ROCK, AR 72211-3737
(501) 227-6363
(501) 227-8629
Mailing address
904 AUTUMN RD, SUITE 200, LITTLE ROCK, AR 72211-3737
(501) 227-6363
(501) 227-8629
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
MC0079
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111026102
—
AR
Enumeration date
05/08/2006
Last updated
05/31/2022
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