Provider Demographics
NPI:1629182761
Name:C DEATON MADDOX MD PA
Entity Type:Organization
Organization Name:C DEATON MADDOX MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:C DEATON
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-253-2865
Mailing Address - Street 1:417 BILTMORE AVE
Mailing Address - Street 2:4-B DOCTOR'S PARK
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4543
Mailing Address - Country:US
Mailing Address - Phone:828-253-2865
Mailing Address - Fax:828-253-9694
Practice Address - Street 1:417 BILTMORE AVE
Practice Address - Street 2:4-B DOCTOR'S PARK
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4543
Practice Address - Country:US
Practice Address - Phone:828-253-2865
Practice Address - Fax:828-253-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC53700OtherBCBS
NC8953700Medicaid