Provider Demographics
NPI:1275357790
Name:VAUGHN, JODI MARLISA (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:MARLISA
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 OLD ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-6614
Mailing Address - Country:US
Mailing Address - Phone:478-251-1728
Mailing Address - Fax:
Practice Address - Street 1:145 1ST ST UPPR LEVEL
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2627
Practice Address - Country:US
Practice Address - Phone:478-212-6814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN216195363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health