Provider Demographics
NPI:1699769059
Name:VAUGHN, BARRY RICHARD (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:RICHARD
Last Name:VAUGHN
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 1:935 SPRING CREEK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-3993
Mailing Address - Country:US
Mailing Address - Phone:423-664-4787
Mailing Address - Fax:423-664-4784
Practice Address - Street 1:935 SPRING CREEK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3993
Practice Address - Country:US
Practice Address - Phone:423-664-4787
Practice Address - Fax:423-664-4784
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28151207X00000X
GA042470207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00718814AMedicaid
TN38067151OtherMCR ID
TN38067151OtherMCR ID