Healthcare Provider Details

I. General information

NPI: 1366479974
Provider Name (Legal Business Name): ALTON RAY KNIGHT II MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 UNIVERSITY AVE
SEWANEE TN
37383-2000
US

IV. Provider business mailing address

205 JACKSON ST
COWAN TN
37318-3366
US

V. Phone/Fax

Practice location:
  • Phone: 931-598-1293
  • Fax: 931-598-1673
Mailing address:
  • Phone: 931-598-1293
  • Fax: 931-598-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: