Provider Demographics
NPI:1659777282
Name:STEPHEN KNOWLTON MD
Entity Type:Organization
Organization Name:STEPHEN KNOWLTON MD
Other - Org Name:KNOWLTON FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KNOWLTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-349-7114
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27323-0330
Mailing Address - Country:US
Mailing Address - Phone:336-349-7114
Mailing Address - Fax:336-361-0022
Practice Address - Street 1:601 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-4621
Practice Address - Country:US
Practice Address - Phone:336-349-7114
Practice Address - Fax:336-361-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC49865OtherBCBS
NC49865OtherBCBS