Provider Demographics
NPI:1669959722
Name:DOHERTY, PAIGE SMITH (LAT, ATC)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:SMITH
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 PIPERS RIDGE CIR NW
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-8096
Mailing Address - Country:US
Mailing Address - Phone:336-953-4072
Mailing Address - Fax:
Practice Address - Street 1:200 LASSO DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6648
Practice Address - Country:US
Practice Address - Phone:478-542-4918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-22
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-38662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer