Healthcare Provider Details

I. General information

NPI: 1093800609
Provider Name (Legal Business Name): ROBERT MICKEY MAUGHON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 EAST PARKWAY
GATLINBURG TN
37738-1015
US

IV. Provider business mailing address

PO BOX 1518
PIGWON FORGE TN
37868-1518
US

V. Phone/Fax

Practice location:
  • Phone: 865-436-7267
  • Fax: 865-430-4179
Mailing address:
  • Phone: 865-365-1510
  • Fax: 865-365-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD16795
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: