Provider Demographics
NPI:1376509315
Name:DEATON, PAUL MCNEELY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MCNEELY
Last Name:DEATON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:3531 MARY ADER AVE
Practice Address - Street 2:BLDG. A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5896
Practice Address - Country:US
Practice Address - Phone:843-744-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC7426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00982684OtherRAILROAD MEDICARE ID-RSFPN
SCP00648638OtherRAILROAD MEDICARE ID
SC074261Medicaid
SCB916199223Medicare PIN
SC074261Medicaid