Provider Demographics
NPI:1275038549
Name:KNOP, JULIE GRACE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:GRACE
Last Name:KNOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 UNIVERSITY WAY
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35042-7501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4208 EVA RD STE B
Practice Address - Street 2:
Practice Address - City:EVA
Practice Address - State:AL
Practice Address - Zip Code:35621-7629
Practice Address - Country:US
Practice Address - Phone:256-735-4154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-132644207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine