# WASATCH G O D MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114897345
- **Authorized official:** TYREE KNIGHT (MANAGER)
- **Authorized official phone:** (385) 612-1794

## Contact information

- **Practice address:** 2480 S MAIN ST STE 108, SOUTH SALT LAKE, UT 84115-5002
- **Practice address phone:** (385) 612-1794
- **Mailing address:** 2480 S MAIN ST STE 108, SOUTH SALT LAKE, UT 84115-5002
- **Mailing address phone:** (385) 612-1794

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |

## Other

- **Enumeration date:** 11/11/2025
- **Last updated:** 11/11/2025