Healthcare Provider Details

I. General information

NPI: 1710818844
Provider Name (Legal Business Name): ERIC PAUL VAUGHN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 KENNESTONE HOSPITAL BLVD
MARIETTA GA
30060-1152
US

IV. Provider business mailing address

340 KENNESTONE HOSPITAL BLVD STE 100
MARIETTA GA
30060-1158
US

V. Phone/Fax

Practice location:
  • Phone: 470-793-7451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRPH030049
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: