Provider Demographics
NPI:1093172199
Name:VAUGHN, PAUL (SCAT, ATC, OPE-C)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:SCAT, ATC, OPE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 CANALSIDE ST UNIT 1008
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-6029
Mailing Address - Country:US
Mailing Address - Phone:318-376-2528
Mailing Address - Fax:
Practice Address - Street 1:1 FALCON DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-738-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC5325932255A2300X
LAATH.J002022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer