Individual
JOHN MICHAEL DOROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA
Contact information
Practice address
161 RAYMONDS GRANT TRCE, SAINT SIMONS ISLAND, GA 31522-5393
(912) 638-9734
Mailing address
161 RAYMONDS GRANT TRCE, SAINT SIMONS ISLAND, GA 31522-5393
(912) 571-0808
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001777
GA
367H00000X
Anesthesiologist Assistant
AA91
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001809A
—
GA
05
—
100001811B
—
GA
01
—
P00410144
RRB
GA
Enumeration date
05/04/2006
Last updated
07/31/2013
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