Provider Demographics
NPI:1821179086
Name:KNIGHT, TASHA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:TASHA
Middle Name:M
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2575 SNAPFINGER RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-2300
Mailing Address - Country:US
Mailing Address - Phone:770-323-0113
Mailing Address - Fax:770-323-2442
Practice Address - Street 1:2575 SNAPFINGER RD
Practice Address - Street 2:SUITE G
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-2300
Practice Address - Country:US
Practice Address - Phone:770-323-0113
Practice Address - Fax:770-323-2442
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0124031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000925746BMedicaid