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Individual

MICHAEL JAMES DOUGHERTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
200 PATEWWOD DRIVE, SUITE A200, GREENVILLE, SC 29615-3585
(864) 454-5125
(864) 241-9201
Mailing address
1 INDEPENDENCE PT STE 212, GREENVILLE, SC 29615-4536

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
32324
SC
208000000X
Pediatrics Physician
M4041
TX
2080P0206X
Pediatric Gastroenterology Physician
Primary
32324
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
323242
SC
Enumeration date
09/22/2006
Last updated
03/23/2018
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