Provider Demographics
NPI:1508909599
Name:KNIGHT, CECIL DEWAYNE (MD, ATC)
Entity Type:Individual
Prefix:DR
First Name:CECIL
Middle Name:DEWAYNE
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:MD, ATC
Other - Prefix:DR
Other - First Name:C.
Other - Middle Name:DEWAYNE
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, ATC
Mailing Address - Street 1:250 CENTENARY AVE NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-4423
Mailing Address - Country:US
Mailing Address - Phone:423-614-8437
Mailing Address - Fax:423-614-8438
Practice Address - Street 1:2003 PARKER STREET MCKENZIE ATHLETIC FACILITY
Practice Address - Street 2:LEE UNIVERSITY BOX 3450
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37320-3450
Practice Address - Country:US
Practice Address - Phone:423-614-8437
Practice Address - Fax:423-614-8438
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN 010104 MD390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program