Individual
DR. JOEL FULLER VAUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
109 BEE ST, CHARLESTON, SC 29401-5703
(843) 577-5011
Mailing address
2200 SANDPIPER RD, VIRGINIA BEACH, VA 23456-4620
(843) 556-9785
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
23927
SC
208000000X
Pediatrics Physician
23927
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
239272
—
SC
Enumeration date
05/19/2006
Last updated
06/12/2019
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