Individual
GLEN N DOUGHERTY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2001 LAUREL ST, COLUMBIA, SC 29204-1018
(803) 254-3278
(803) 929-3256
Mailing address
PO BOX 935722, ATLANTA, GA 31193-5722
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
28734
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287344
—
SC
Enumeration date
06/13/2006
Last updated
08/24/2021
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