Provider Demographics
NPI:1093169468
Name:VAUGHT, SHERRY PHILLIPS (ATC)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:PHILLIPS
Last Name:VAUGHT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4073 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-8117
Mailing Address - Country:US
Mailing Address - Phone:615-337-2987
Mailing Address - Fax:
Practice Address - Street 1:4073 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-8117
Practice Address - Country:US
Practice Address - Phone:615-337-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000297172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker