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General NPI Number Information
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NPI Number | 1407056369
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Entity Type | Individual
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Provider Name | LELA RENEE MCKNIGHT-EILY PHD
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Gender | Female
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 698 N MARIETTA PKWY NE
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City | MARIETTA
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State | GA
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Zip | 30060-1529
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Country | US
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Telephone | 770-919-9088
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Fax | 770-919-8708
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Provider Business Mailing Address
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Address Line | 4770 BUFORD HWY MAILSTOP 67
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City | ATLANTA
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State | GA
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Zip | 30341-3717
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Country | US
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Telephone | 770-488-8124
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY002804
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License Number State | GA
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