Provider Demographics
NPI:1417937418
Name:KNECHT, LANCE H (MD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:H
Last Name:KNECHT
Suffix:
Gender:M
Credentials:MD
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 1039
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-0023
Mailing Address - Country:US
Mailing Address - Phone:770-601-2252
Mailing Address - Fax:
Practice Address - Street 1:1050 MALCOM BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2894
Practice Address - Country:US
Practice Address - Phone:770-601-2252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP5212085R0202X
GA0563132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000540472OtherBCBS PROVIDER NUMBER
GA099546306Medicaid
TX201235305Medicaid
KY7100019200Medicaid
GA30BDMDLMedicare ID - Type Unspecified
TX201235305Medicaid
KYP00447068Medicare PIN
KY000000540472OtherBCBS PROVIDER NUMBER
KY7100019200Medicaid
TXTXB108833Medicare PIN
KY00151025Medicare PIN