Provider Demographics
NPI:1720027063
Name:KNOER, JAMES CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CHARLES
Last Name:KNOER
Suffix:
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 1:567 CLEBURNE TER NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1421
Mailing Address - Country:US
Mailing Address - Phone:404-584-6696
Mailing Address - Fax:
Practice Address - Street 1:315 WINN WAY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2111
Practice Address - Country:US
Practice Address - Phone:404-299-9724
Practice Address - Fax:215-829-3701
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-069018-L207V00000X
GA057714207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2896326OtherAETNA
PA3741237-001OtherCIGNA
PA001904531001Medicaid
PA063442HDDMedicare ID - Type Unspecified
PA2896326OtherAETNA
PA3741237-001OtherCIGNA