Provider Demographics
NPI:1184698136
Name:MADDEN, DARYL CLINTON (PA-C)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:CLINTON
Last Name:MADDEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 ENON SPRINGS RD E
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-4446
Mailing Address - Country:US
Mailing Address - Phone:615-223-6200
Mailing Address - Fax:
Practice Address - Street 1:519 ENON SPRINGS RD E
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4446
Practice Address - Country:US
Practice Address - Phone:615-223-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4723363A00000X
TN4862363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA044378N8ZMedicare ID - Type Unspecified
S40457Medicare UPIN