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General NPI Number Information
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NPI Number | 1962974493
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Entity Type | Organization
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Legal Business Name | DIABETES AND WOUND CARE CLINIC OF ST GEORGE
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Dates
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Enumeration Date | 12/21/2018
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 1054 E RIVERSIDE DR STE 201
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City | ST GEORGE
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State | UT
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Zip | 84790-4829
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Country | US
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Telephone | 435-574-5123
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Fax | 435-634-8894
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Provider Business Mailing Address
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Address Line | 1054 E RIVERSIDE DR STE 201
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City | ST GEORGE
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State | UT
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Zip | 84790-4829
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Country | US
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Telephone | 435-574-5123
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Fax | 435-634-8894
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Authorized Official
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Title or Position | PARTNER
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Name | JAMIE KNIGHT
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Credential |
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Telephone | 801-860-9240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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