Provider Demographics
NPI:1972617744
Name:KNIGHT, HAVON (MD)
Entity type:Individual
Prefix:
First Name:HAVON
Middle Name:
Last Name:KNIGHT
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 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:615-314-5257
Mailing Address - Fax:615-692-0547
Practice Address - Street 1:5740 N GRAHAM ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-4839
Practice Address - Country:US
Practice Address - Phone:704-251-8340
Practice Address - Fax:980-549-3832
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC160487207R00000X
IL036.151442207R00000X
MEMD23630207R00000X
ALMD.43824207R00000X
MS15597207R00000X
GA041448207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1559117OtherAMERICAN ADMIN GROUP
MS00118828Medicaid
GA041448OtherGA MEDICAL LICENSE
LA1501573Medicaid
110001210Medicare ID - Type Unspecified
110186276Medicare ID - Type UnspecifiedRAILROAD MEDICARE
GA041448OtherGA MEDICAL LICENSE
GAP00707249Medicare PIN
MS00118828Medicaid