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General NPI Number Information
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NPI Number | 1790743300
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Entity Type | Individual
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Provider Name | MARK ALLAN KNAUTZ MEDICAL DOCTOR
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 5041 DALLAS HWY SUITE D
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-6458
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Country | US
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Telephone | 770-427-5467
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Fax | 770-427-6340
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Provider Business Mailing Address
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Address Line | 111 MARBLE MILL RD NW
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City | MARIETTA
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State | GA
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Zip | 30060-1047
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Country | US
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Telephone | 770-422-1013
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Fax | 770-514-5996
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 041328
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License Number State | GA
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