Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 4721 | GA |
NPI | 1871634667 |
---|---|
Provider Name | Dr. Michael Andrew Vaughn |
First Address | Savannah, GA 31406-3606 |
Second Address | Savannah, GA 31406-3606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 25/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000519109A | (05) | GA |
U11765 | (02) | GA |