Provider Demographics
NPI:1780783415
Name:MADDOX, CYNTHIA M (PAC)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:M
Last Name:MADDOX
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:CINDY
Other - Middle Name:M
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:SKYLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28776-0254
Mailing Address - Country:US
Mailing Address - Phone:828-708-9876
Mailing Address - Fax:828-708-9876
Practice Address - Street 1:800 N JUSTICE ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3410
Practice Address - Country:US
Practice Address - Phone:352-273-6815
Practice Address - Fax:352-392-4533
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2896363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290209500Medicaid
FL290209500Medicaid
FLU1594ZMedicare PIN
FLU1594YMedicare PIN