Provider Demographics
NPI:1740281252
Name:HALL, VAUGHAN DABNEY (MD)
Entity type:Individual
Prefix:
First Name:VAUGHAN
Middle Name:DABNEY
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT 888182
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-0001
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:180 EMORY RD
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:TN
Practice Address - Zip Code:37709-2420
Practice Address - Country:US
Practice Address - Phone:865-933-4110
Practice Address - Fax:865-933-4729
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3811803Medicaid
TN3811803Medicaid
TN3811807Medicare ID - Type Unspecified