Healthcare Provider Details

I. General information

NPI: 1780783415
Provider Name (Legal Business Name): CYNTHIA M MADDOX PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CINDY M MADDOX PA-C

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 01/26/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N JUSTICE ST
HENDERSONVILLE NC
28791-3410
US

IV. Provider business mailing address

PO BOX 254
SKYLAND NC
28776-0254
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6815
  • Fax: 352-392-4533
Mailing address:
  • Phone: 828-708-9876
  • Fax: 828-708-9876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2896
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: