Organization
COLLEGE PARK FAMILY CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GIL E JOHNSON MD (CEO PRESIDENT)
(501) 327-6041
Entity
Organization
Contact information
Practice address
2511-A COLLEGE AVE, CONWAY, AR 72034
(501) 327-6041
(501) 327-6043
Mailing address
2511-A COLLEGE AVE, CONWAY, AR 72034
(501) 327-6041
(501) 327-6043
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
C6340
AR
207Q00000X
Family Medicine Physician
C6340
AR
208000000X
Pediatrics Physician
C6340
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11451000000
QC
AR
Enumeration date
12/19/2005
Last updated
09/11/2025
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