Healthcare Provider Details

I. General information

NPI: 1558386821
Provider Name (Legal Business Name): GEORGE DENNIS VAUGHAN III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 DEVONSHIRE DR STE 100
COLUMBIA SC
29204-2444
US

IV. Provider business mailing address

1551 BEN SAWYER BLVD UNIT 46
MT PLEASANT SC
29464-5509
US

V. Phone/Fax

Practice location:
  • Phone: 803-758-5858
  • Fax: 803-758-5855
Mailing address:
  • Phone: 843-881-0061
  • Fax: 703-997-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number10035
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: