Healthcare Provider Details

I. General information

NPI: 1871634667
Provider Name (Legal Business Name): MICHAEL ANDREW VAUGHN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 COMMERCIAL DR
SAVANNAH GA
31406-3606
US

IV. Provider business mailing address

345 COMMERCIAL DR
SAVANNAH GA
31406-3606
US

V. Phone/Fax

Practice location:
  • Phone: 912-356-0031
  • Fax: 912-356-5471
Mailing address:
  • Phone: 912-356-0031
  • Fax: 912-356-5471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number4721
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: