Provider Demographics
NPI:1225229255
Name:DOUGHERTY-BASILA, KATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:DOUGHERTY-BASILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 AL HIGHWAY 75 N
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-3838
Mailing Address - Country:US
Mailing Address - Phone:256-891-0300
Mailing Address - Fax:256-891-7461
Practice Address - Street 1:460 AL HIGHWAY 75 N
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951-3838
Practice Address - Country:US
Practice Address - Phone:256-891-7461
Practice Address - Fax:256-891-7461
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244455208000000X
TN43730208000000X
AL38700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics