Provider Demographics
NPI:1013957521
Name:JON H. DOCHERTY, MD
Entity Type:Organization
Organization Name:JON H. DOCHERTY, MD
Other - Org Name:PEE DEE INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:H
Authorized Official - Last Name:DOCHERTY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-667-8561
Mailing Address - Street 1:514 S DARGAN ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2552
Mailing Address - Country:US
Mailing Address - Phone:843-667-8561
Mailing Address - Fax:843-673-0206
Practice Address - Street 1:514 S DARGAN ST
Practice Address - Street 2:SUITE G
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2552
Practice Address - Country:US
Practice Address - Phone:843-667-8561
Practice Address - Fax:843-673-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC077552Medicaid