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General NPI Number Information
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NPI Number | 1629310958
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Entity Type | Organization
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Legal Business Name | VAUGHAN PHYSICIAN PRACTICES, LLC
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Dates
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Enumeration Date | 03/25/2013
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 1013 MEDICAL CENTER PKWY BLDG 2
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City | SELMA
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State | AL
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Zip | 36701-6742
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Country | US
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Telephone | 334-418-4113
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Fax | 334-418-3599
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Provider Business Mailing Address
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Address Line | 200 VAUGHAN MEMORIAL DR
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City | SELMA
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State | AL
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Zip | 36701-6508
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Country | US
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Telephone | 334-418-4113
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Fax | 334-418-3599
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Authorized Official
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Title or Position | DIRECTOR
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Name | PHILLIP L COWART
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Credential |
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Telephone | 334-418-4113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | AL
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