Provider Demographics
NPI:1063520880
Name:DOUGHERTY, WILLIAM L (PAC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:L
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:615 S HANSELL ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5556
Mailing Address - Country:US
Mailing Address - Phone:229-226-2234
Mailing Address - Fax:229-226-2237
Practice Address - Street 1:615 S HANSELL ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5556
Practice Address - Country:US
Practice Address - Phone:229-226-2234
Practice Address - Fax:229-226-2237
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA002982363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant