Basic Information
| Provider Information | |||||||||
| NPI: | 1043621246 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOUGHTON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 MANNING DR | ||||||||
| Address2: | CB # 7595 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199660210 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 590 MANNING DR # 7595 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199660210 | ||||||||
| FaxNumber: | 9199666125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2014 | ||||||||
| LastUpdateDate: | 08/09/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2017-01176 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.