Healthcare Provider Details

I. General information

NPI: 1881734945
Provider Name (Legal Business Name): EDWARD BERT KNIGHT 111, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 N CHURCH PL
SPARTANBURG SC
29303-2706
US

IV. Provider business mailing address

PO BOX 4276
SPARTANBURG SC
29305-4276
US

V. Phone/Fax

Practice location:
  • Phone: 864-582-6858
  • Fax: 864-585-0999
Mailing address:
  • Phone: 864-582-6858
  • Fax: 864-585-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number8397
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number8397
License Number StateSC

VIII. Authorized Official

Name: DR. EDWARD BERT KNIGHT III
Title or Position: PRESIDENT
Credential: MD
Phone: 864-582-6858