Larry D. Daugherty, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10020 Issued in GA

Practice address

124 Island Professional Park
St Simons Island, GA 31522

Phone

(912) 434-4121

Fax

(912) 268-2847

NPI assigned

Oct 19, 2006

Last updated

Feb 24, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487894400000",
    "number": "1053493486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 ISLAND PROFESSIONAL PARK",
            "city": "ST SIMONS ISLAND",
            "state": "GA",
            "postal_code": "315222879",
            "telephone_number": "912-434-4121",
            "fax_number": "912-268-2847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 ISLAND PROFESSIONAL PARK",
            "city": "ST SIMONS ISLAND",
            "state": "GA",
            "postal_code": "31522",
            "telephone_number": "912-434-4121",
            "fax_number": "912-268-2847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAUGHERTY",
        "first_name": "LARRY",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2017-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "10020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crane Physical Therapy and Wellness
• Mary Beth Currey, LPC
• Elizabeth Thompson Daniel, PT
• William W. Daniels Jr., M.D.
• Katrina Dare, OT
• Barbara Davanzo, M.D.
• David E Vincent MD PC
• David L Patterson, PC
• Hannah Davis, NP-C
• Angela Kathleen Dawson, MD

• General Practice Dentistry in St Simons Island, GA
• Providers in St Simons Island, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.