Individual
MR. GARY CHRISTOPOHER DAUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
107 WILEY CEMETERY LN, ROCKY TOP, TN 37769-5700
(865) 659-7611
Mailing address
107 WILEY CEMETERY LN, ROCKY TOP, TN 37769-5700
(865) 659-7611
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
88802
TN
Other
Enumeration date
01/01/2024
Last updated
01/01/2024
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