Racquel Lewis Vaughn, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN014917 Issued in GA

Practice address

3983 Lavista Rd Ste 104
Tucker, GA 30084-5140

Phone

(770) 723-1111

NPI assigned

Aug 19, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Georgia Dental Professionals, PC

  dba Family Dentistry of Northlake

  • General Practice Dentistry
  • Tucker, GA
  • NPI 1215315312
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657584000000",
    "number": "1871809582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3983 LAVISTA RD STE 104",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300845140",
            "telephone_number": "770-723-1111",
            "fax_number": "770-723-9444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3983 LAVISTA RD STE 104",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300845140",
            "telephone_number": "770-723-1111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2239 Highway 20 SE",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "300132091",
            "country_code": "US",
            "telephone_number": "770-921-3565",
            "fax_number": "770-921-3534",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAUGHN",
        "first_name": "RACQUEL",
        "middle_name": "LEWIS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-19",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN014917",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN19195",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN014917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracey J Van Dyke, MA S/T
• Peter Victor Vanstrom, DDS
• Gina Ann Varco, MSN, APRN, AGACNP-BC
• Geetanjali Vasandani, MD
• Kyra Emonee Vaughan
• Erica Velker
• Izabella Verbitsky, M.D., PH.D.
• Verras Pediatrics PC
• Athanasios Verras, MD
• Adrian Verwayne

• General Practice Dentistry in Tucker, GA
• Providers in Tucker, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.