Provider Demographics
NPI:1861404295
Name:VAUGHN, CHRISTOPHER MARK (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MARK
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 1:58 BIG A RD
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-6017
Mailing Address - Country:US
Mailing Address - Phone:706-886-9693
Mailing Address - Fax:706-886-7843
Practice Address - Street 1:58 BIG A RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-6017
Practice Address - Country:US
Practice Address - Phone:706-886-9693
Practice Address - Fax:706-886-7843
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA45999207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000871978AMedicaid
GA045999OtherSTATE LICENSE
GA000871978BMedicaid
BV5970858OtherDEA NUMBER
BV5970858OtherDEA NUMBER
GA000871978AMedicaid
GAH15755Medicare UPIN
GA000871978BMedicaid
200043500Medicare ID - Type UnspecifiedRAILROAD MEDICARE
GA339670Medicaid
GA10057530Medicaid
BV5970858OtherDEA NUMBER
GA962148OtherSTATE MERIT-RICHMOND HILL
GA962148OtherBCBS OF GA - 2D LOCATION
GA746971OtherBCBS OF GA- MAIN OFFICE