MEDICARE: DR. CECIL DEWAYNE KNIGHT M.D., ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	TN 010104 MD	TN

General Provider Information

NPI Number	:	1508909599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CECIL DEWAYNE KNIGHT M.D., ATC

Provider Business Mailing Address
First Line	:	250 CENTENARY AVE NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-4423
Country	:	US
Telephone Number	:	423-614-8437
Fax Number	:	423-614-8438

Provider Business Practice Location Address
First Line	:	2003 PARKER STREET MCKENZIE ATHLETIC FACILITY
Second Line	:	LEE UNIVERSITY BOX 3450
City	:	CLEVELAND
State	:	TN
Zip	:	37320-3450
Country	:	US
Telephone Number	:	423-614-8437
Fax Number	:	423-614-8438

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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