Healthcare Provider Details

I. General information

NPI: 1720027063
Provider Name (Legal Business Name): JAMES CHARLES KNOER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 WINN WAY
DECATUR GA
30030-2111
US

IV. Provider business mailing address

567 CLEBURNE TER NE
ATLANTA GA
30307-1421
US

V. Phone/Fax

Practice location:
  • Phone: 404-299-9724
  • Fax: 215-829-3701
Mailing address:
  • Phone: 404-584-6696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD-069018-L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number057714
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: