Provider Demographics
NPI:1760568687
Name:BRAY, VAUGHN GILBERT (MCD, CCC-A)
Entity Type:Individual
Prefix:
First Name:VAUGHN
Middle Name:GILBERT
Last Name:BRAY
Suffix:
Gender:M
Credentials:MCD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 LYNDA LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-1251
Mailing Address - Country:US
Mailing Address - Phone:706-569-1308
Mailing Address - Fax:706-327-0860
Practice Address - Street 1:4334 ARMOUR RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5322
Practice Address - Country:US
Practice Address - Phone:706-327-8459
Practice Address - Fax:706-327-0860
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003392231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA600-20698OtherBCBS OF GEORGIA WESTECH
GA00669952AMedicaid
AL510-50435OtherBCBS OF ALABAMA
GA64BCBLHMedicare ID - Type UnspecifiedVBA MEDICARE
GA64BCBJMMedicare ID - Type UnspecifiedWESTECH MEDICARE