Provider Demographics
NPI:1609933837
Name:VAUGHN, RHONDA SULENE (RPT)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:SULENE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7136 GREENLEAVES CT
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-7601
Mailing Address - Country:US
Mailing Address - Phone:770-836-5251
Mailing Address - Fax:770-214-0708
Practice Address - Street 1:7136 GREENLEAVES CT
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-7601
Practice Address - Country:US
Practice Address - Phone:770-836-5251
Practice Address - Fax:770-214-0708
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA340906OtherWELLCARE OF GEORGIA
GA127433OtherPEACH STATE HEALTH PLAN
GA10052061OtherAMERIGROUP
GAPT002308OtherPRACTICE LICENSE
GA340906OtherWELLCARE OF GEORGIA
GA65BBDLXMedicare ID - Type Unspecified