Provider Demographics
NPI:1497710750
Name:VAUGHN, MARY BELL HANCOCK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY BELL
Middle Name:HANCOCK
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3448 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-1867
Mailing Address - Country:US
Mailing Address - Phone:478-405-0045
Mailing Address - Fax:478-405-0054
Practice Address - Street 1:3448 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-1867
Practice Address - Country:US
Practice Address - Phone:478-405-0045
Practice Address - Fax:478-405-0054
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA049552OtherMEDICAL LICENSE
GA00960165AMedicaid
GA1497710750OtherNPI
GABV7200669OtherDEA
GABV7200669OtherDEA
GA11BDVLKMedicare PIN