Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 1-132644 | AL |
NPI | 1275038549 |
---|---|
Provider Name | Julie Grace Knop |
First Address | Centreville, AL 35042-7501 |
Second Address | Centreville, AL 35042-7501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2018 |
Last Update Date | 28/03/2018 |