Healthcare Provider Details

I. General information

NPI: 1174487565
Provider Name (Legal Business Name): VIRGINIA KNUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HEMBREE RD
ROSWELL GA
30076-5719
US

IV. Provider business mailing address

PO BOX 740329
ATLANTA GA
30374-0329
US

V. Phone/Fax

Practice location:
  • Phone: 770-230-6221
  • Fax:
Mailing address:
  • Phone: 317-502-3512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: