Healthcare Provider Details

I. General information

NPI: 1790055903
Provider Name (Legal Business Name): THE KNIGHT GROUP INCORPORATED OF GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 JOWERS RD
WHIGHAM GA
39897-2162
US

IV. Provider business mailing address

382 JOWERS RD PO BOX 409
WHIGHAM GA
39897-2162
US

V. Phone/Fax

Practice location:
  • Phone: 229-762-3150
  • Fax: 229-762-3110
Mailing address:
  • Phone: 229-762-3150
  • Fax: 229-762-3110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number065010161
License Number StateGA

VIII. Authorized Official

Name: MS. LINDA K GORDON
Title or Position: ADMINSTRATOR
Credential:
Phone: 229-762-3150