Healthcare Provider Details

I. General information

NPI: 1932448453
Provider Name (Legal Business Name): MAUGHON FAMILY CARE CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E PARKWAY
GATLINBURG TN
37738-5057
US

IV. Provider business mailing address

1015 E PARKWAY
GATLINBURG TN
37738-5057
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT M MAUGHON
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 865-436-7267