Provider Demographics
NPI:1083738074
Name:VAUGHAN, CATHY WHITE
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:WHITE
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WHITLOCK AVE SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1944
Mailing Address - Country:US
Mailing Address - Phone:770-428-5959
Mailing Address - Fax:
Practice Address - Street 1:1001 WHITLOCK AVE SW
Practice Address - Street 2:SUITE A
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1944
Practice Address - Country:US
Practice Address - Phone:770-428-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice