Provider Demographics
NPI:1467769992
Name:STEPHEN H. KNIGHT M.D.
Entity Type:Organization
Organization Name:STEPHEN H. KNIGHT M.D.
Other - Org Name:NORTHLAKE EYE & CATARACT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-491-3700
Mailing Address - Street 1:1459 MONTREAL RD
Mailing Address - Street 2:STE 501
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084
Mailing Address - Country:US
Mailing Address - Phone:770-491-3700
Mailing Address - Fax:770-491-7581
Practice Address - Street 1:1459 MONTREAL RD
Practice Address - Street 2:STE 501
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:770-491-3700
Practice Address - Fax:770-491-7581
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHEN H. KNIGHT M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028586207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00335222BMedicaid
GAD29951Medicare UPIN
505862134BMedicare Oscar/Certification