Provider Demographics
NPI:1255404273
Name:VAUGHN, JAMES O (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:O
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1750
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-1612
Mailing Address - Country:US
Mailing Address - Phone:910-270-0997
Mailing Address - Fax:910-270-0984
Practice Address - Street 1:14905 US HIGHWAY 17 N
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3391
Practice Address - Country:US
Practice Address - Phone:910-270-0997
Practice Address - Fax:910-270-0984
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100010363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2755582BMedicare ID - Type UnspecifiedMEDICARE PROVIDER
NCP82888Medicare UPIN