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General NPI Number Information
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NPI Number | 1083235972
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Entity Type | Individual
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Provider Name | RAKETRA RONTRESE KNIGHT PA
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Gender | Female
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Dates
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Enumeration Date | 05/01/2020
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 830 EAGLES LANDING PKWY STE 202
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7366
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Country | US
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Telephone | 707-991-2176
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Fax |
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Provider Business Mailing Address
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Address Line | 860 GLENWOOD AVE SE APT 223
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City | ATLANTA
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State | GA
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Zip | 30316-1994
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Country | US
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Telephone | 903-244-2469
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 11022
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License Number State | GA
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