Organization
TILLEY DIAGNOSTIC CLINIC
Active
Other names
Pinnacle Physicians Group
Organization subpart
No
Provider details
NPI number
Authorized official
ABSALOM H TILLEY M.D. (OWNER)
(501) 337-5678
Entity
Organization
Contact information
Practice address
1003 SCHNEIDER DR, MALVERN, AR 72104-4811
(501) 337-5678
(501) 332-6759
Mailing address
1003 SCHNEIDER DR, MALVERN, AR 72104-4811
(501) 337-5678
(501) 332-6759
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
C7758
AR
207RR0500X
Rheumatology Physician
E5172
AR
208000000X
Pediatrics Physician
E5062
AR
363A00000X
Physician Assistant
GL008
AR
363L00000X
Nurse Practitioner
P01341
AR
363LF0000X
Family Nurse Practitioner
A01943
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149122002
—
AR
Enumeration date
08/05/2006
Last updated
12/09/2020
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