Dickson Street Clinic

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

C4954 Issued in AR

Legal business name

DICKSON STREET CLINIC

Practice address

102 W Dickson St
Fayetteville, AR 72701-5219

Phone

(479) 521-1114

Fax

(479) 521-2540

NPI assigned

Feb 6, 2008

Last updated

Feb 6, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Carl R Magness, MDNPI 1548345606

Title

Owner/Physician

Phone

(479) 521-1114

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carl Robert Magness, M.D.

  • Adult Medicine Physician
  • Fayetteville, AR
  • NPI 1548345606
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202256000000",
    "number": "1427236926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 W DICKSON ST",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727015219",
            "telephone_number": "479-521-1114",
            "fax_number": "479-521-2540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 W DICKSON ST",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727015219",
            "telephone_number": "479-521-1114",
            "fax_number": "479-521-2540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKSON STREET CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-06",
        "last_updated": "2008-02-06",
        "status": "A",
        "authorized_official_last_name": "MAGNESS",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "479-521-1114",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "AR",
            "license": "C4954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harrison Dickens
• Amanda Dickerson, PTA
• James Michael Dickerson, D.C.
• Megie Kathleen Dickinson, M.S. CCC-SLP
• Tiffany Rhett Dickinson
• Ernestine Dickson, MSW, LCSW
• Jonathan David Dickson, PA-C
• Dawn Allyson Didier, ATC, LAT
• Shawna Kay Digby, RN, MNSC
• Bradley Dilday, M.D.

• Adult Medicine Physician in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Adult Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.