{"npi":"1720021553","type":"NPI-1","status":"active","name":{"display":"Glen Dougherty MD","other":[],"first":"GLEN","last":"DOUGHERTY","middle":"N","credential":"MD"},"specialty":{"primary_taxonomy":"207RC0000X","primary_taxonomy_description":"Cardiovascular Disease","slug":"cardiology","schema_org_specialty":"Cardiovascular","all":[{"code":"207RC0000X","description":"Cardiovascular Disease","primary":true,"state":"SC","license":"28734"}]},"addresses":[{"purpose":"LOCATION","street_1":"2001 LAUREL ST","city":"COLUMBIA","state":"SC","postal_code":"292041018","country_code":"US","phone":"8032543278","fax":"8039293256"},{"purpose":"MAILING","street_1":"PO BOX 935722","city":"ATLANTA","state":"GA","postal_code":"311935722","country_code":"US","phone":"8437926200"}],"license":{"state":"SC","number":"28734"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"287344","state":"SC","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20060712000317","type_code":"14-06","type_desc":"PRACTITIONER - CARDIOVASCULAR DISEASE (CARDIOLOGY)","state":"SC","pac_id":"0042228330"}]},"enumeration_date":"2006-06-13","last_updated":"2021-08-24","_meta":{"source":"NPPES","snapshot_date":"2021-08-24","doc_url":"https://findmynpi.com/api"}}