Basic Information
Provider Information
NPI: 1659482867
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KNAUF
FirstName: CONSTANCE
MiddleName: W
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: WILLIAMS
OtherFirstName: CONSTANCE
OtherMiddleName: CHRISTINE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 3495 PIEDMONT ROAD NE
Address2: NINE PIEDMONT CENTER
City: ATLANTA
State: GA
PostalCode: 303051736
CountryCode: US
TelephoneNumber: 4043647000
FaxNumber:  
Practice Location
Address1: 200 CRESCENT CENTRE PARK
Address2: DEPARTMENT OF OBSTETRICS& GYNECOLOGY
City: TUCKER
State: GA
PostalCode: 30084
CountryCode: US
TelephoneNumber: 7704963525
FaxNumber: 7704963709
Other Information
ProviderEnumerationDate: 08/31/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XRN090530GAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


Home