Provider Demographics
NPI:1851361489
Name:KNIGHT, EDWARD BERT III (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:BERT
Last Name:KNIGHT
Suffix:III
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 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6012
Practice Address - Fax:864-560-6013
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8397207R00000X, 207RH0002X
SC08397207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC083974Medicaid
SCP00454115OtherRR MEDICARE
SC576007863172OtherBCBS
SCP01722207OtherRAILROAD MEDICARE
SC576007863172OtherBCBS
C84958Medicare UPIN
SCP01722207OtherRAILROAD MEDICARE
SCC849586904Medicare PIN
SCC849587951Medicare PIN