Provider Demographics
NPI:1184958613
Name:VAUGHN, MARSHA ELAINE
Entity type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:ELAINE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7098 SIR CHARLES CT
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-3236
Mailing Address - Country:US
Mailing Address - Phone:678-973-6049
Mailing Address - Fax:
Practice Address - Street 1:7098 SIR CHARLES CT
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-3236
Practice Address - Country:US
Practice Address - Phone:678-973-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator