Provider Demographics
NPI:1821031840
Name:DAUGHERTY, TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
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 1:4451 PAULSEN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3664
Mailing Address - Country:US
Mailing Address - Phone:912-350-7500
Mailing Address - Fax:912-350-7735
Practice Address - Street 1:4451 PAULSEN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3664
Practice Address - Country:US
Practice Address - Phone:912-350-7500
Practice Address - Fax:912-350-7735
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000603886BMedicaid
SCG37781Medicaid
GA110236207OtherRR MEDICARE
F78098Medicare UPIN
GA110236207OtherRR MEDICARE