Provider Demographics
NPI:1891808069
Name:VAUGHN, JULIE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:E
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4880 HARKEY LN
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2863
Mailing Address - Country:US
Mailing Address - Phone:205-333-8222
Mailing Address - Fax:205-333-8233
Practice Address - Street 1:4880 HARKEY LN
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2863
Practice Address - Country:US
Practice Address - Phone:205-333-8222
Practice Address - Fax:205-333-8233
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL176932080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51037121OtherBCBS PROVIDER NUMBER
AL000037121Medicaid
AL000037121Medicaid