Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 052971 | GA |
N | 207QA0401X | Family Doctor - Addiction Medicine | 052971 | GA |
NPI | 1104975002 |
---|---|
Provider Name | Dr. William Joseph Keating |
First Address | Dawsonville, GA 30534-5546 |
Second Address | Dawsonville, GA 30534-0989 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 21/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000385310A | (05) | GA |
10050796 | AMERIGROUP (01) | GA |
325908 | WELLCARE (01) | GA |
E62904 | (02) |