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General NPI Number Information
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NPI Number | 1124607031
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Entity Type | Individual
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Provider Name | JACOB WALKER VAUGHT DO
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Gender | Male
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 2750 DANTZLER DR UNIT 102
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-9006
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Country | US
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Telephone | 843-876-1818
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 751461
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City | CHARLOTTE
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State | NC
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Zip | 28275-1461
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Country | US
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Telephone | 843-792-1414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 94543
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 94543
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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