Basic Information
| Provider Information | |||||||||
| NPI: | 1689084865 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAUGHN | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | RUSSELL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 E WEISGARBER RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379092675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655844747 | ||||||||
| FaxNumber: | 8655841363 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 HOSPITAL DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377605279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644754742 | ||||||||
| FaxNumber: | 8652620100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2014 | ||||||||
| LastUpdateDate: | 06/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD0000057030 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | MD0000057030 | TN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.