Provider Demographics
NPI:1336729987
Name:VAUGHAN, MARNIE JEAN
Entity Type:Individual
Prefix:
First Name:MARNIE
Middle Name:JEAN
Last Name:VAUGHAN
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 1:87 LAVENDER CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0103
Mailing Address - Country:US
Mailing Address - Phone:678-429-0405
Mailing Address - Fax:
Practice Address - Street 1:87 LAVENDER CT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-0103
Practice Address - Country:US
Practice Address - Phone:678-429-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician