Provider Information for 1083926604
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Mr. MATTHEW G VAUGHN L.P.C.
Sex: Male
NPI: 1083926604
Last Updated: 2010-07-12
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1083926604 | ||||||||
| Enumeration Date | 2010-07-12 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4015 S COBB DR SE SUITE 100 SMYRNA, GA 30080-6303 United States Phone: 770-851-3823 | Fax:770-863-0009 | ||||||||
| Primary Practice Address | 4015 S COBB DR SE SUITE 100 SMYRNA, GA 30080-6303 United States Phone: 770-851-3823 | Fax:770-863-0009 | ||||||||
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