Healthcare Provider Details

I. General information

NPI: 1265994842
Provider Name (Legal Business Name): HILLARY ELIZABETH CLEMENTS DAUGHERTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 AZALEA DR STE A
OXFORD MS
38655-5397
US

IV. Provider business mailing address

504 AZALEA DR STE A
OXFORD MS
38655-5397
US

V. Phone/Fax

Practice location:
  • Phone: 662-636-4444
  • Fax:
Mailing address:
  • Phone: 662-636-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number30362
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: