Healthcare Provider Details

I. General information

NPI: 1407277460
Provider Name (Legal Business Name): VAUGHAN PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 MEDICAL CENTER PKWY SUITE 310
SELMA AL
36701-6780
US

IV. Provider business mailing address

PO BOX 1206
SELMA AL
36702-1206
US

V. Phone/Fax

Practice location:
  • Phone: 334-418-6656
  • Fax: 334-418-6657
Mailing address:
  • Phone: 334-418-6656
  • Fax: 334-418-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JESS JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-372-8500