Provider Demographics
NPI:1982021721
Name:PAUL S DAUGHERTY MD PC
Entity Type:Organization
Organization Name:PAUL S DAUGHERTY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-826-3111
Mailing Address - Street 1:PO BOX 1734
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37077-1734
Mailing Address - Country:US
Mailing Address - Phone:615-826-3111
Mailing Address - Fax:615-826-3112
Practice Address - Street 1:107 IMPERIAL BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3479
Practice Address - Country:US
Practice Address - Phone:615-826-3111
Practice Address - Fax:615-826-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3167876Medicare UPIN