Individual
DR. JOHN THOMAS DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
110 EXECUTIVE PARK DR, CLINTON, TN 37716-6876
(865) 494-9241
(865) 494-2522
Mailing address
110 EXECUTIVE PARK DR, CLINTON, TN 37716-6876
(865) 494-9241
(865) 494-2522
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD0000021373
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080030188
RAILROAD MEDICARE
TN
01
—
125762
BLUE CROSS
TN
05
—
3062410
—
TN
Enumeration date
10/06/2005
Last updated
01/09/2009
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