Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 061110 | GA |
N | 204F00000X | Transplant Surgeon | 30135 | WI |
NPI | 1013971670 |
---|---|
Provider Name | Stuart J Knechtle |
First Address | Atlanta, GA 30322-0001 |
Second Address | Atlanta, GA 30322-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 19/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31646500 | (05) | WI |
E96067 | (02) |