Individual
LAURA ANNE VAUGHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14 RICHLAND MEDICAL PARK DR STE 350, COLUMBIA, SC 29203-6896
(803) 434-1663
(803) 434-3894
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1812
SC
363AM0700X
Medical Physician Assistant
PA9103537
FL
363AS0400X
Surgical Physician Assistant
PA9103537
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1501PA
—
SC
Enumeration date
05/20/2006
Last updated
06/08/2022
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