Provider Demographics
NPI:1629310958
Name:VAUGHAN PHYSICIAN PRACTICES, LLC
Entity Type:Organization
Organization Name:VAUGHAN PHYSICIAN PRACTICES, LLC
Other - Org Name:VAUGHAN FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:COWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-418-4113
Mailing Address - Street 1:200 VAUGHAN MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6508
Mailing Address - Country:US
Mailing Address - Phone:334-418-4113
Mailing Address - Fax:334-418-3599
Practice Address - Street 1:1013 MEDICAL CENTER PKWY BLDG 2
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6742
Practice Address - Country:US
Practice Address - Phone:334-418-4113
Practice Address - Fax:334-418-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty