Provider Demographics
NPI:1548332505
Name:MCKNIGHT, BENNY MARTIN (DO)
Entity type:Individual
Prefix:DR
First Name:BENNY
Middle Name:MARTIN
Last Name:MCKNIGHT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1095 N ELLINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-2228
Mailing Address - Country:US
Mailing Address - Phone:931-359-0185
Mailing Address - Fax:931-359-2487
Practice Address - Street 1:1095 N ELLINGTON PKWY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2228
Practice Address - Country:US
Practice Address - Phone:931-359-0185
Practice Address - Fax:931-359-2487
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621449003Medicare UPIN