Healthcare Provider Details

I. General information

NPI: 1013957521
Provider Name (Legal Business Name): JON H. DOCHERTY, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 S DARGAN ST SUITE G
FLORENCE SC
29506-2552
US

IV. Provider business mailing address

514 S DARGAN ST SUITE G
FLORENCE SC
29506-2552
US

V. Phone/Fax

Practice location:
  • Phone: 843-667-8561
  • Fax: 843-673-0206
Mailing address:
  • Phone: 843-667-8561
  • Fax: 843-673-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JON H DOCHERTY SR.
Title or Position: OWNER
Credential: M.D.
Phone: 843-667-8561