MEDICARE: DR. KIMBERLY JILL STOUGHTON-DOHERTY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	055981	GA

General Provider Information

NPI Number	:	1154326932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY JILL STOUGHTON-DOHERTY MD

Provider Business Mailing Address
First Line	:	2040 DAN PROCTOR DR.
Second Line	:	SUITE 140
City	:	ST. MARYS
State	:	GA
Zip	:	31558
Country	:	US
Telephone Number	:	912-673-8000
Fax Number	:	912-673-8003

Provider Business Practice Location Address
First Line	:	2040 DAN PROCTOR DR.
Second Line	:	SUITE 140
City	:	ST. MARYS
State	:	GA
Zip	:	31558
Country	:	US
Telephone Number	:	912-673-8000
Fax Number	:	912-673-8008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	11/04/2016

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