Provider Demographics
NPI:1518934082
Name:DRAUGHON, THOMAS SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:SCOTT
Last Name:DRAUGHON
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 1:201 N BREAZEALE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-1603
Mailing Address - Country:US
Mailing Address - Phone:919-658-4954
Mailing Address - Fax:919-658-5754
Practice Address - Street 1:201 N BREAZEALE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-1603
Practice Address - Country:US
Practice Address - Phone:919-658-4954
Practice Address - Fax:919-658-5754
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89135KHMedicaid
NC2023294Medicare PIN
NC89135KHMedicaid