Provider Demographics
NPI:1386920080
Name:VAUGHN, AMANDA J (PHARM D)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 N EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-1269
Mailing Address - Country:US
Mailing Address - Phone:770-227-3397
Mailing Address - Fax:770-227-5841
Practice Address - Street 1:1602 N EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-1269
Practice Address - Country:US
Practice Address - Phone:770-227-3397
Practice Address - Fax:770-227-5841
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist