Healthcare Provider Details

I. General information

NPI: 1740640606
Provider Name (Legal Business Name): WENDY C KNIGHT RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 REYNOLDS PL
BUFORD GA
30518-9219
US

IV. Provider business mailing address

4207 REYNOLDS PL
BUFORD GA
30518-9219
US

V. Phone/Fax

Practice location:
  • Phone: 678-231-0343
  • Fax:
Mailing address:
  • Phone: 678-231-0343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-28068
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN160467
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: