Healthcare Provider Details

I. General information

NPI: 1598772436
Provider Name (Legal Business Name): MICHAEL A. KNIGHT SR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5106 OAK ST
EASTMAN GA
31023
US

IV. Provider business mailing address

5106 OAK ST
EASTMAN GA
31023
US

V. Phone/Fax

Practice location:
  • Phone: 478-268-4959
  • Fax: 478-268-4959
Mailing address:
  • Phone: 478-268-4959
  • Fax: 478-268-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10635
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: