Organization
CONWAY PSYCHIATRIC CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND HARLECH CLARK M.D. (DOCTOR)
(501) 472-7697
Entity
Organization
Contact information
Practice address
5330 PLANTATION CV, CONWAY, AR 72034-8586
(501) 472-7697
Mailing address
PO BOX 10705, CONWAY, AR 72034-0012
(501) 472-7697
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
C-8236
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129952001
—
AR
Enumeration date
01/20/2011
Last updated
01/20/2011
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