MEDICARE: DR. ROBERT A. VAUGHT D.M.D.,M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	11121	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	813625	OTHER	GA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1033412036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT A. VAUGHT D.M.D.,M.S.

Provider Business Mailing Address
First Line	:	PO BOX 1918
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-1918
Country	:	US
Telephone Number	:	912-756-2309
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 US HIGHWAY 17
Second Line	:	SUITE 2B
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-3799
Country	:	US
Telephone Number	:	912-756-2309
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2010
Last Update Date	:	04/19/2012

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