Provider Demographics
NPI:1265066955
Name:THOMAS W ATKINSON MD PA
Entity type:Organization
Organization Name:THOMAS W ATKINSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-582-5905
Mailing Address - Street 1:PO BOX 9690
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0030
Mailing Address - Country:US
Mailing Address - Phone:479-582-5905
Mailing Address - Fax:479-582-5908
Practice Address - Street 1:1670 EAST JOYCE BLVD SUITE 2
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-0030
Practice Address - Country:US
Practice Address - Phone:479-582-5905
Practice Address - Fax:479-582-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110911001Medicaid