Provider Demographics
NPI:1164964946
Name:VAUGHAN, THOMAS W (HIS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 GERMANTOWN BEND CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4243
Mailing Address - Country:US
Mailing Address - Phone:901-751-2245
Mailing Address - Fax:888-798-6190
Practice Address - Street 1:303 GERMANTOWN BEND CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4243
Practice Address - Country:US
Practice Address - Phone:901-751-2245
Practice Address - Fax:888-798-6190
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN676237700000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist