Executive Medical Practice L.L.C.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

EXECUTIVE MEDICAL PRACTICE L.L.C.

Practice address

1455 Bells Ferry Rd Ste 100
Marietta, GA 30066-6078

Phone

(770) 421-8094

Fax

(770) 421-8096

NPI assigned

Mar 28, 2023

Last updated

Aug 21, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rashelle Fox

Title

Creditialing

Phone

(404) 664-2997

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ken Gordon Knott, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Marietta, GA
  • NPI 1053359034
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1265136923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 BELLS FERRY RD STE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300666078",
            "telephone_number": "770-421-8094",
            "fax_number": "770-421-8096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 BELLS FERRY RD STE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300666078",
            "telephone_number": "770-421-8094",
            "fax_number": "770-421-8096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE MEDICAL PRACTICE L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-28",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "RASHELLE",
        "authorized_official_title_or_position": "CREDITIALING",
        "authorized_official_telephone_number": "404-664-2997"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Physical Medicine & Rehabilitation Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.