Provider Demographics
NPI:1013971670
Name:KNECHTLE, STUART J (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:J
Last Name:KNECHTLE
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 1:5105 WMB
Mailing Address - Street 2:101 WOODRUFF CIRCLE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-0001
Mailing Address - Country:US
Mailing Address - Phone:404-712-7944
Mailing Address - Fax:404-727-3660
Practice Address - Street 1:5105 WMB
Practice Address - Street 2:101 WOODRUFF CIRCLE
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-0001
Practice Address - Country:US
Practice Address - Phone:404-712-7944
Practice Address - Fax:404-727-3660
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30135204F00000X
GA061110204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31646500Medicaid
WI31646500Medicaid
020215875Medicare ID - Type Unspecified