Healthcare Provider Details

I. General information

NPI: 1134811094
Provider Name (Legal Business Name): ALEXANDER PRIOR DAUGHERTY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 PALMER RD STE 103
MADISON AL
35758-3115
US

IV. Provider business mailing address

810 PALMER RD STE 103
MADISON AL
35758-3115
US

V. Phone/Fax

Practice location:
  • Phone: 256-542-9456
  • Fax:
Mailing address:
  • Phone: 256-542-9456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD.007526-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: