Healthcare Provider Details

I. General information

NPI: 1033574157
Provider Name (Legal Business Name): TEYANA MORRIS-KNIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 2ND AVE
COLUMBUS GA
31901-5241
US

IV. Provider business mailing address

1402 PARK AVE N
TIFTON GA
31794-3431
US

V. Phone/Fax

Practice location:
  • Phone: 706-321-9606
  • Fax: 706-322-6576
Mailing address:
  • Phone: 334-540-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: