Healthcare Provider Details

I. General information

NPI: 1750351359
Provider Name (Legal Business Name): DAVID R KNOPF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5354 REYNOLDS ST STE 102
SAVANNAH GA
31405-6007
US

IV. Provider business mailing address

7505 WATERS AVE STE. C8
SAVANNAH GA
31406-3825
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-2116
  • Fax: 912-355-3653
Mailing address:
  • Phone: 912-352-2606
  • Fax: 912-352-0623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number025199
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number15773
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierG25199
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 2
Identifier908957800
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer
# 3
Identifier00303751A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 4
Identifier1784494
Identifier TypeMEDICAID
Identifier StateLA
Identifier Issuer
# 5
Identifier235405
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerBCBSGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: