Provider Demographics
NPI:1831528009
Name:DAUGHERTY, MARCIA LYNN
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:LYNN
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4190 OLD MILTON PKWY
Mailing Address - Street 2:SUITE 2K
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-6459
Mailing Address - Country:US
Mailing Address - Phone:678-389-6669
Mailing Address - Fax:
Practice Address - Street 1:4190 OLD MILTON PKWY
Practice Address - Street 2:SUITE 2K
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-6459
Practice Address - Country:US
Practice Address - Phone:678-389-6669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant