MEDICARE: DR. SAMUEL FREDERICK VAUGHT AUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	3479	GA

General Provider Information

NPI Number	:	1992706154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL FREDERICK VAUGHT AUD

Provider Business Mailing Address
First Line	:	2176 OAK RD STE D
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2374
Country	:	US
Telephone Number	:	770-972-4327
Fax Number	:	770-972-4101

Provider Business Practice Location Address
First Line	:	2176 OAK RD STE D
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2374
Country	:	US
Telephone Number	:	770-972-4327
Fax Number	:	770-927-4101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/29/2024

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