MEDICARE: DR. MARY GREEN KNOX M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2000-01589	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043273550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY GREEN KNOX M.D.

Provider Business Mailing Address
First Line	:	10900 WORLD TRADE BLVD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-4202
Country	:	US
Telephone Number	:	919-237-1337
Fax Number	:	919-237-1625

Provider Business Practice Location Address
First Line	:	5821 FAIRVIEW RD STE 106
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3649
Country	:	US
Telephone Number	:	704-826-3550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	03/07/2022

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