Provider Demographics
NPI:1427054923
Name:VAUGHN, CANDACE FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:FREDERICK
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:CANDACE
Other - Middle Name:ELIZABETH
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:478-218-0839
Practice Address - Street 1:750 TOWNPARK LANE
Practice Address - Street 2:KAISER PERMANENTE TOWNPARK COMPREHENSIVE MEDICAL CENTER
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144
Practice Address - Country:US
Practice Address - Phone:770-514-5401
Practice Address - Fax:478-218-0839
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000744147FMedicaid
GA000744147FMedicaid