Provider Demographics
NPI:1407056369
Name:MCKNIGHT-EILY, LELA RENEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LELA
Middle Name:RENEE
Last Name:MCKNIGHT-EILY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LELA
Other - Middle Name:RENEE
Other - Last Name:MCKNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4770 BUFORD HWY
Mailing Address - Street 2:MAILSTOP 67
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3717
Mailing Address - Country:US
Mailing Address - Phone:770-488-8124
Mailing Address - Fax:
Practice Address - Street 1:698 N MARIETTA PKWY NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1529
Practice Address - Country:US
Practice Address - Phone:770-919-9088
Practice Address - Fax:770-919-8708
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002804103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical