Healthcare Provider Details

I. General information

NPI: 1154772747
Provider Name (Legal Business Name): DALE EDWARD KNIGHT JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EDDIE KNIGHT RN

II. Dates (important events)

Enumeration Date: 06/25/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761B MAN BONE CREEK RD
WHIGHAM GA
39897-2409
US

IV. Provider business mailing address

761B MAN BONE CREEK RD
WHIGHAM GA
39897-2409
US

V. Phone/Fax

Practice location:
  • Phone: 229-378-4242
  • Fax: 229-377-0676
Mailing address:
  • Phone: 229-378-4242
  • Fax: 229-377-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN258421
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: