Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2274 | TN |
N | 111NI0900X | Internist | 2274 | TN |
NPI | 1003041641 |
---|---|
Provider Name | Bradley Rayford Keel |
First Address | Atlanta, GA 30368-0001 |
Second Address | Chattanooga, TN 37404-1161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2009 |
Last Update Date | 10/07/2012 |