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General NPI Number Information
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NPI Number | 1275038549
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Entity Type | Individual
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Provider Name | JULIE GRACE KNOP
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Gender | Female
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 4208 EVA RD STE B
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City | EVA
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State | AL
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Zip | 35621-7629
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Country | US
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Telephone | 256-735-4154
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Fax |
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Provider Business Mailing Address
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Address Line | 909 UNIVERSITY WAY
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City | CENTREVILLE
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State | AL
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Zip | 35042-7501
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Country | US
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Telephone |
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 1-132644
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License Number State | AL
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