Provider Demographics
NPI:1598076606
Name:VAUGHAN, BOBBY
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:VAUGHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:113 US 158-258
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27855
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 MOORE ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:NC
Practice Address - Zip Code:27855-1223
Practice Address - Country:US
Practice Address - Phone:252-398-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health