Provider Demographics
NPI:1912183120
Name:DRAUGHON, DARRELL JAMES (RADIOLOGIC TECHNOLOG)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:JAMES
Last Name:DRAUGHON
Suffix:
Gender:M
Credentials:RADIOLOGIC TECHNOLOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-5443
Mailing Address - Country:US
Mailing Address - Phone:910-918-2687
Mailing Address - Fax:
Practice Address - Street 1:435 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-5443
Practice Address - Country:US
Practice Address - Phone:910-918-2687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34X0009823247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409823Medicaid
NC2530304Medicare PIN