Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 87798 | GA |
NPI | 1023463395 |
---|---|
Provider Name | Dr. Christopher Gatlin Keith |
First Address | Mcdonough, GA 30253-4310 |
Second Address | Austell, GA 30106-8116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2016 |
Last Update Date | 04/05/2021 |