MEDICARE: GEORGE TIPTON MCKNIGHT MD

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	207RN0300X	Nephrology Physician	L008749	LA

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	:	1780715193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE TIPTON MCKNIGHT MD

Provider Business Mailing Address
First Line	:	8334 O'HARA COURT
Second Line	:	SUITE D
City	:	BATON ROUGE
State	:	LA
Zip	:	70806
Country	:	US
Telephone Number	:	225-924-0190
Fax Number	:	225-923-2107

Provider Business Practice Location Address
First Line	:	8334 O'HARA COURT
Second Line	:	SUITE D
City	:	BATON ROUGE
State	:	LA
Zip	:	70806
Country	:	US
Telephone Number	:	225-924-0190
Fax Number	:	225-923-2107

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	05/22/2012

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