Provider Demographics
NPI:1316277338
Name:MCKNIGHT BARON, AISHA JENELLE (MD)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:JENELLE
Last Name:MCKNIGHT BARON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AISHA
Other - Middle Name:JENELLE
Other - Last Name:MCKNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-0128
Mailing Address - Country:US
Mailing Address - Phone:281-833-3330
Mailing Address - Fax:281-833-3323
Practice Address - Street 1:1300 HAWTHORNE AVE SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2136
Practice Address - Country:US
Practice Address - Phone:678-540-1144
Practice Address - Fax:678-540-1166
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68934208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery