Individual
LISA MARIE DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
660 LAKE JOY RD STE D, KATHLEEN, GA 31047-2382
(478) 313-5385
Mailing address
1200 CORPORATE DR STE 400, HOOVER, AL 35242-5424
(866) 518-0283
(423) 238-3628
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT006185
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000950573A
—
GA
01
—
52676665
BLUE CROSS BLUE SHIELD
GA
Enumeration date
08/23/2006
Last updated
02/22/2024
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