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General NPI Number Information
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NPI Number | 1851685150
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Entity Type | Organization
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Legal Business Name | VAUGHN H. MANCHA, JR., P.C.
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Dates
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Enumeration Date | 06/03/2011
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | 17328 BURWICK LOOP
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City | FAIRHOPE
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State | AL
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Zip | 36532-5243
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Country | US
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Telephone | 334-300-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 17328 BURWICK LOOP
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City | FAIRHOPE
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State | AL
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Zip | 36532-5243
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Country | US
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Telephone | 334-300-2573
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Fax |
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MRS. DEBORAH B MANCHA
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Credential |
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Telephone | 334-300-2573
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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 | 14167
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License Number State | AL
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