Individual
DWAYNE T DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2801 N DECATUR RD, SUITE 300, DECATUR, GA 30033-5949
(404) 296-3111
(678) 686-9521
Mailing address
2801 N DECATUR RD, SUITE 300, DECATUR, GA 30033-5949
(404) 296-3111
(678) 686-9521
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
030041
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00433386A
—
GA
Enumeration date
08/03/2005
Last updated
11/14/2011
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