Provider Demographics
NPI:1154772747
Name:KNIGHT, DALE EDWARD JR (RN)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:EDWARD
Last Name:KNIGHT
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:EDDIE
Other - Middle Name:
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:761B MAN BONE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WHIGHAM
Mailing Address - State:GA
Mailing Address - Zip Code:39897-2409
Mailing Address - Country:US
Mailing Address - Phone:229-378-4242
Mailing Address - Fax:229-377-0676
Practice Address - Street 1:761B MAN BONE CREEK RD
Practice Address - Street 2:
Practice Address - City:WHIGHAM
Practice Address - State:GA
Practice Address - Zip Code:39897-2409
Practice Address - Country:US
Practice Address - Phone:229-378-4242
Practice Address - Fax:229-377-0676
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-25
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN258421163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA23152549OtherNATIONAL COUNCIL OF STATE BOARDS OF NURSING INC. ID#
GARN258421OtherRN LICENSE, GA
GAPENDINGMedicare PIN