Healthcare Provider Details

I. General information

NPI: 1255494332
Provider Name (Legal Business Name): AUBREY LEE KNIGHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 CRYSTAL SPRING AVE SW SUITE 302
ROANOKE VA
24014-2462
US

IV. Provider business mailing address

2001 CRYSTAL SPRING AVE SW SUITE 302
ROANOKE VA
24014-2462
US

V. Phone/Fax

Practice location:
  • Phone: 540-981-7653
  • Fax: 540-981-7469
Mailing address:
  • Phone: 540-981-7653
  • Fax: 540-981-7469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberD0035281
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number0101035672
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: