Provider Demographics
NPI:1174942528
Name:GUTHRIE, JACEY TANNER (MD)
Entity type:Individual
Prefix:DR
First Name:JACEY
Middle Name:TANNER
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4200 N RODNEY PARHAM RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2460
Mailing Address - Country:US
Mailing Address - Phone:501-227-4323
Mailing Address - Fax:501-227-4149
Practice Address - Street 1:4200 N RODNEY PARHAM RD STE 202
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212
Practice Address - Country:US
Practice Address - Phone:501-227-4323
Practice Address - Fax:501-227-4149
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-11347207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology