Provider Demographics
NPI:1417004813
Name:VAUGHAN, WILLIAM H JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:VAUGHAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 JOE HALL RD
Mailing Address - Street 2:P.O. BOX A
Mailing Address - City:FLORA
Mailing Address - State:MS
Mailing Address - Zip Code:39071-9669
Mailing Address - Country:US
Mailing Address - Phone:601-879-8867
Mailing Address - Fax:601-878-3314
Practice Address - Street 1:1968 JOE HALL RD
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:MS
Practice Address - Zip Code:39071-9669
Practice Address - Country:US
Practice Address - Phone:601-879-8867
Practice Address - Fax:601-878-3314
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS055032084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00112824Medicaid
MSC75924Medicare UPIN