Provider Demographics
NPI:1821199571
Name:KNAPP, RICHARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:KNAPP
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 1:175 WHITETAIL RD
Mailing Address - Street 2:
Mailing Address - City:SEALE
Mailing Address - State:AL
Mailing Address - Zip Code:36875-5917
Mailing Address - Country:US
Mailing Address - Phone:423-384-1708
Mailing Address - Fax:615-234-3762
Practice Address - Street 1:175 WHITETAIL ROAD
Practice Address - Street 2:
Practice Address - City:SEALE
Practice Address - State:AL
Practice Address - Zip Code:36875-5917
Practice Address - Country:US
Practice Address - Phone:423-384-1708
Practice Address - Fax:615-234-3762
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33968207ZP0102X
GA32223282N00000X
ALMD.30846291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No282N00000XHospitalsGeneral Acute Care Hospital
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000000018792OtherTLC TENNCARE
TN100031094OtherPHP TENNCARE
TN3850367Medicaid
GA52022505005OtherBLUE CROSS
VA006601294Medicaid
TN119582OtherUNISON TENNCARE
NC89063F3Medicaid
VA286997OtherBLUE CROSS
TN3143364OtherBLUE CROSS
GA319800OtherWELLCARE MEDCAID CMO
KY64057102Medicaid
TN100031094OtherPHP TENNCARE
E90690Medicare UPIN
TN3850367Medicare ID - Type Unspecified
TN3850367Medicaid