Provider Demographics
NPI:1386920700
Name:VAUGHN, RHONDA L (RN)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:L
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 STONE PARK DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-1625
Mailing Address - Country:US
Mailing Address - Phone:770-617-0384
Mailing Address - Fax:770-726-7781
Practice Address - Street 1:229 STONE PARK DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188
Practice Address - Country:US
Practice Address - Phone:770-617-0384
Practice Address - Fax:770-726-7781
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN141904367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA794223724BMedicaid