Provider Demographics
NPI:1558386821
Name:VAUGHAN, GEORGE DENNIS III (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:DENNIS
Last Name:VAUGHAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1551 BEN SAWYER BLVD UNIT 46
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5509
Mailing Address - Country:US
Mailing Address - Phone:843-881-0061
Mailing Address - Fax:703-997-1470
Practice Address - Street 1:1611 DEVONSHIRE DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2444
Practice Address - Country:US
Practice Address - Phone:803-758-5858
Practice Address - Fax:803-758-5855
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC10035207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC10035OtherLICENSE