Provider Demographics
NPI:1548242118
Name:KNOBLE, JEANNA LYNN (MD)
Entity Type:Individual
Prefix:MISS
First Name:JEANNA
Middle Name:LYNN
Last Name:KNOBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:239-432-8331
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:3100 PLAZA PROPERTIES BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1530
Practice Address - Country:US
Practice Address - Phone:614-383-6000
Practice Address - Fax:614-383-6001
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.085443207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I44594Medicare UPIN
VAGC1100Medicare PIN
VAC20675Medicare PIN
VAP00351674Medicare PIN