Provider Demographics
NPI:1255083697
Name:VAUGHN, KATHERINE MARIE (CNM)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:CNM
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:915 HIGHLAND SQUARE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2295
Mailing Address - Country:US
Mailing Address - Phone:910-262-0752
Mailing Address - Fax:
Practice Address - Street 1:10692 MEDLOCK BRIDGE RD STE 100A
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-8497
Practice Address - Country:US
Practice Address - Phone:404-446-2496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife