Provider Demographics
NPI:1174031959
Name:KNOX, TREMAIN KENDERIC
Entity Type:Individual
Prefix:
First Name:TREMAIN
Middle Name:KENDERIC
Last Name:KNOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3666
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-3666
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30522 GARNAND DRIVE
Practice Address - Street 2:
Practice Address - City:EMORY
Practice Address - State:VA
Practice Address - Zip Code:24327
Practice Address - Country:US
Practice Address - Phone:276-870-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program