Individual
SHANNON JOE VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
28 JOHN DAVENPORT DR NW, ROME, GA 30165-2536
(706) 235-8485
(706) 295-5742
Mailing address
420 E 2ND AVE STE 103, ROME, GA 30161-3210
(706) 509-3000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
046000
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00798509A
—
GA
Enumeration date
07/14/2006
Last updated
03/10/2023
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