Provider Demographics
NPI:1538489562
Name:VAUGHAN, TODD BAGWELL (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:BAGWELL
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1314 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4116
Mailing Address - Country:US
Mailing Address - Phone:601-703-3018
Mailing Address - Fax:601-703-9283
Practice Address - Street 1:1221 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:35470-5410
Practice Address - Country:US
Practice Address - Phone:205-652-9575
Practice Address - Fax:205-652-7979
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALMD.31197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine