College Park Family Clinic PA

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

C6340 Issued in AR

Legal business name

COLLEGE PARK FAMILY CLINIC PA

Practice address

2511-A College Ave
Conway, AR 72034

Phone

(501) 327-6041

Fax

(501) 327-6043

NPI assigned

Dec 19, 2005

Organization subpart

No

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

Authorized official

Name

Gil E Johnson, MDNPI 1356563241

Title

Ceo President

Phone

(501) 327-6041

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gil Johnson, M.D.

  • Adult Medicine Physician
  • Conway, AR
  • NPI 1356563241
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1861478232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2511-A COLLEGE AVE",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "72034",
            "telephone_number": "501-327-6041",
            "fax_number": "501-327-6043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2511-A COLLEGE AVE",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "72034",
            "telephone_number": "501-327-6041",
            "fax_number": "501-327-6043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEGE PARK FAMILY CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-19",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "GIL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO PRESIDENT",
        "authorized_official_telephone_number": "501-327-6041",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "AR",
            "license": "C6340",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C6340",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "C6340",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QC",
            "identifier": "11451000000",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vanessa Cole, QBHP
• Dedra Coleman, RECOVERY ASSISTANT
• Lynsey Lynn Coleman
• Morgan Coleman, DNP, PMHNP-BC, APRN
• College Avenue Operating LLC
• Jhasmine Collier, QBHP
• Ashlea N Collins
• Christopher Collins, RECOVERY ASSISTANT
• Coryn Collins, LMFT, LPC
• Margarete Collins, RDN

• Emergency Medicine Physician in Conway, AR
• Providers in Conway, AR by specialty
• Emergency Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.