Provider Demographics
NPI:1720014723
Name:DAUGHERTY, STEPHEN FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FRANKLIN
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 DUNLOP LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5015
Mailing Address - Country:US
Mailing Address - Phone:931-551-8991
Mailing Address - Fax:931-551-4053
Practice Address - Street 1:647 DUNLOP LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5015
Practice Address - Country:US
Practice Address - Phone:931-551-8991
Practice Address - Fax:931-551-4053
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000022208174400000X
TN222082086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3066580Medicaid
TN3066580Medicaid
TN3066582Medicare PIN