Provider Demographics
NPI:1093800609
Name:MAUGHON, ROBERT MICKEY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICKEY
Last Name:MAUGHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1518
Mailing Address - Street 2:
Mailing Address - City:PIGWON FORGE
Mailing Address - State:TN
Mailing Address - Zip Code:37868-1518
Mailing Address - Country:US
Mailing Address - Phone:865-365-1510
Mailing Address - Fax:865-365-1610
Practice Address - Street 1:1015 EAST PARKWAY
Practice Address - Street 2:
Practice Address - City:GATLINBURG
Practice Address - State:TN
Practice Address - Zip Code:37738-1015
Practice Address - Country:US
Practice Address - Phone:865-436-7267
Practice Address - Fax:865-430-4179
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD16795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100010733Medicaid
TN3023149Medicaid
TN57934OtherBLUE CROSS BLUE SHIELD
TN3023149Medicaid
TN3023140Medicare PIN
TN100010733Medicaid