Healthcare Provider Details

I. General information

NPI: 1851155303
Provider Name (Legal Business Name): MCKNIGHT CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WOODBRIDGE RD STE A
SOMERVILLE TN
38068-1242
US

IV. Provider business mailing address

25 WOODBRIDGE RD STE A
SOMERVILLE TN
38068-1242
US

V. Phone/Fax

Practice location:
  • Phone: 901-465-6353
  • Fax:
Mailing address:
  • Phone: 901-465-6353
  • Fax: 833-902-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH P MCKNIGHT
Title or Position: PARTNER
Credential:
Phone: 901-465-6353