Provider Demographics
NPI:1053359034
Name:KNOTT, KEN GORDON (MD)
Entity type:Individual
Prefix:DR
First Name:KEN
Middle Name:GORDON
Last Name:KNOTT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1455 BELLS FERRY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6078
Mailing Address - Country:US
Mailing Address - Phone:770-421-8094
Mailing Address - Fax:770-421-8096
Practice Address - Street 1:1455 BELLS FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6078
Practice Address - Country:US
Practice Address - Phone:770-421-8094
Practice Address - Fax:770-421-8096
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA024282208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation