Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 11121 | GA |
NPI | 1033412036 |
---|---|
Provider Name | Dr. Robert A. Vaught |
First Address | Richmond Hill, GA 31324-1918 |
Second Address | Richmond Hill, GA 31324-3799 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2010 |
Last Update Date | 19/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
813625 | UNITED CONCORDIA (01) | GA |