Provider Demographics
NPI:1275769135
Name:DOUGHERTY-WELCH, STACY D (MD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:D
Last Name:DOUGHERTY-WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:D
Other - Last Name:DOUGHERTY-WELCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:315 BOULEVARD NE, STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1212
Mailing Address - Country:US
Mailing Address - Phone:404-265-3635
Mailing Address - Fax:404-265-3634
Practice Address - Street 1:315 BOULEVARD NE
Practice Address - Street 2:STE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1212
Practice Address - Country:US
Practice Address - Phone:404-265-3635
Practice Address - Fax:404-265-3634
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC157387208600000X
GA69797208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery