Brock Jackson Daughtry, DO

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

833 Princeton Ave SW
Birmingham, AL 35211-1323

Phone

(205) 783-3098

NPI assigned

Apr 21, 2020

Last updated

Apr 21, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Interoperability endpoints

• Direct secure messaging: bdaughtry4539038@direct.trinity-health.org

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

{
    "created_epoch": "1587427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587427200000",
    "number": "1083234942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 PRINCETON AVE SW",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352111323",
            "telephone_number": "205-783-3098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 PRINCETON AVE SW",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352111323",
            "telephone_number": "205-783-3098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAUGHTRY",
        "first_name": "BROCK",
        "middle_name": "JACKSON",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-21",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sophie Julia Dasoveanu
• Boris Datnow, BORIS DATNOW
• Edward Payson Daugherty, DO
• Trista Daugherty, RBT
• Charlotte Lee Daughhetee, PH.D, M.ED.
• Charles Steven Daughtry, D. M. D.
• Aditi Ashishkumar Dave, MD
• Barry Davenport, LICSW
• Celia Williams Davenport, D.M.D.
• Jennifer Wu Davenport, M.D.

• Student in an Organized Health Care Education/Training Program in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Student in an Organized Health Care Education/Training Program in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.