Provider Demographics
NPI:1992706154
Name:VAUGHT, SAMUEL FREDERICK (AUD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:FREDERICK
Last Name:VAUGHT
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2176 OAK RD STE D
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2374
Mailing Address - Country:US
Mailing Address - Phone:770-972-4327
Mailing Address - Fax:770-972-4101
Practice Address - Street 1:2176 OAK RD STE D
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2374
Practice Address - Country:US
Practice Address - Phone:770-972-4327
Practice Address - Fax:770-927-4101
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3479231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
64BCBJBMedicare ID - Type Unspecified
GAP04491Medicare UPIN