Provider Demographics
NPI:1417028507
Name:MAUGHON, TIMOTHY SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:MAUGHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3855 PLEASANT HILL RD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1407
Mailing Address - Country:US
Mailing Address - Phone:770-813-8888
Mailing Address - Fax:770-813-0007
Practice Address - Street 1:3855 PLEASANT HILL RD
Practice Address - Street 2:SUITE 470
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1407
Practice Address - Country:US
Practice Address - Phone:770-813-8888
Practice Address - Fax:770-813-0007
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA031472207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00525566AMedicaid
GA00525566AMedicaid
GAS-30944Medicare UPIN