Healthcare Provider Details

I. General information

NPI: 1609421890
Provider Name (Legal Business Name): CHRISTA VAUGHAN PARAMORE DNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTA LEE VAUGHAN

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/20/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N. ABC STREET
MILLEDGEVILLE GA
31061-0000
US

IV. Provider business mailing address

PO BOX 371
WRIGHTSVILLE GA
31096-0371
US

V. Phone/Fax

Practice location:
  • Phone: 478-215-4009
  • Fax: 478-864-1288
Mailing address:
  • Phone: 478-864-3448
  • Fax: 478-864-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6785
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: