Provider Demographics
NPI:1962925321
Name:WHITE HALL PRIMARY CARE PLUS PLLC
Entity type:Organization
Organization Name:WHITE HALL PRIMARY CARE PLUS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:870-247-9499
Mailing Address - Street 1:1400 CLAUD RD
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71602-8622
Mailing Address - Country:US
Mailing Address - Phone:870-247-9499
Mailing Address - Fax:870-247-9495
Practice Address - Street 1:1400 CLAUD RD
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71602-8622
Practice Address - Country:US
Practice Address - Phone:870-247-9499
Practice Address - Fax:870-247-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty