Individual
MICHAEL G DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
31 SANDSTONE CIR, JACKSON, TN 38305-2073
(731) 240-1747
(731) 240-1755
Mailing address
31 SANDSTONE CIR, JACKSON, TN 38305-2073
(731) 240-1747
(731) 240-1755
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
68642
TN
2085R0204X
Vascular & Interventional Radiology Physician
4301087295
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
604658400
—
MN
Enumeration date
02/20/2006
Last updated
02/03/2025
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