Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 024282 | GA |
NPI | 1053359034 |
---|---|
Provider Name | Dr. Ken Gordon Knott |
First Address | Marietta, GA 30066-6078 |
Second Address | Marietta, GA 30066-6078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 08/07/2007 |