| Doctor Name: | MR. ARTHUR THOMAS ROACH |
| NPI Number: | 1619967478 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.A.-C. |
| License Number: | PA-025 |
| Business Practice Address: | 3040 Goodman Road, Suite C Horn Lake, MS - 386371189 |
| Business Phone Number: | 6622803428 |
| Business Fax Number: | 6622801736 |
| Mailing Address: | 5185 Nail Road, OLIVE BRANCH |
| State: | MS |
| Postal Code: | 386548245 |
| Phone Number: | 6628956738 |
| Fax Number: | 6622801736 |
| NPI Enumeration Date: | 10/24/2005 |
| NPI Last Update Date: | 11/20/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA-025 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |