Provider Demographics
NPI:1255464376
Name:PIEDMONT PLASTIC SURGERY
Entity Type:Organization
Organization Name:PIEDMONT PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:R
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-223-0505
Mailing Address - Street 1:305A W ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4009
Mailing Address - Country:US
Mailing Address - Phone:864-223-0505
Mailing Address - Fax:864-223-7075
Practice Address - Street 1:305A W ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4009
Practice Address - Country:US
Practice Address - Phone:864-223-0505
Practice Address - Fax:864-223-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC120072086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0728Medicaid
SCGP0728Medicaid