Provider Demographics
NPI:1548221864
Name:BARNICK, VAUGHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:VAUGHN
Middle Name:R
Last Name:BARNICK
Suffix:
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:PO BOX 935722
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-5722
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:2750 LAUREL ST STE 303
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2025
Practice Address - Country:US
Practice Address - Phone:803-252-1953
Practice Address - Fax:803-217-6750
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11769207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC117698Medicaid
SC307055Medicaid
SCB914613957Medicare PIN
SC110100205Medicare PIN