Healthcare Provider Details

I. General information

NPI: 1487000501
Provider Name (Legal Business Name): JESSICA KNIGHT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2016
Last Update Date: 07/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 PINE ST STE 900
MACON GA
31201-2100
US

IV. Provider business mailing address

840 PINE ST STE 900
MACON GA
31201-7500
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-8060
  • Fax: 478-633-4080
Mailing address:
  • Phone: 478-633-8060
  • Fax: 478-633-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN209049
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: