Provider Demographics
NPI:1609870690
Name:KNIGHT, THOMAS E JR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:KNIGHT
Suffix:JR
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 75513
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-0513
Mailing Address - Country:US
Mailing Address - Phone:843-815-9700
Mailing Address - Fax:843-815-9701
Practice Address - Street 1:18 CLARKS SUMMIT DRIVE
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910
Practice Address - Country:US
Practice Address - Phone:843-815-9700
Practice Address - Fax:843-815-9701
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC268442085B0100X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC300133498OtherRAILROAD MEDICARE
SCPL0067Medicaid
H89682Medicare UPIN
SCPL0067Medicaid