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General NPI Number Information
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NPI Number | 1144423005
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Entity Type | Individual
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Provider Name | ALISHA STOCKTON VAUGHN M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 06/25/2009
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Provider Practice Location Address
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Address Line | 151 E METRO DR SUITE 102
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City | FLOWOOD
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State | MS
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Zip | 39232-4402
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Country | US
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Telephone | 601-992-2292
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Fax |
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Provider Business Mailing Address
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Address Line | 358 BRIAR VIEW DR
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City | BRANDON
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State | MS
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Zip | 39042-8228
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Country | US
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Telephone | 601-519-9579
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20656
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License Number State | MS
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