Provider Demographics
NPI:1861438665
Name:ATKINSON, THOMAS W (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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 E JOYCE BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6214
Practice Address - Country:US
Practice Address - Phone:479-582-5905
Practice Address - Fax:479-582-5908
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5953207RA0401X, 207R00000X
ARC-5903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR238882OtherVALUE OPTIONS PROVIDER ID
AR110911001Medicaid
AR13075000001OtherQUALCHOICE QCA
AR50083OtherBLUE CROSS
AR13075000001OtherQUALCHOICE QCA