Provider Demographics
NPI:1407902786
Name:MAYNARD, ARTHUR STANLEY III (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:STANLEY
Last Name:MAYNARD
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 63112
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3112
Mailing Address - Country:US
Mailing Address - Phone:336-274-9617
Mailing Address - Fax:336-482-2177
Practice Address - Street 1:1331 N ELM ST STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6304
Practice Address - Country:US
Practice Address - Phone:336-274-9617
Practice Address - Fax:336-482-2177
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI137922085R0202X
RI148292085R0202X
NC2011-017552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00581612Medicaid
HI00581612Medicaid