Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 49812 | TN |
N | 208600000X | Surgeon | 49812 | TN |
N | 208200000X | Surgeon | 68360 | GA |
N | 208600000X | Surgeon | 68360 | GA |
Y | 2086S0102X | Surgical Critical Care | 49812 | TN |
N | 2086S0102X | Surgical Critical Care | 68360 | GA |
NPI | 1316164288 |
---|---|
Provider Name | John Stewart Keeley JR. |
First Address | Kingsport, TN 37660-3256 |
Second Address | Augusta, GA 30909-2205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 04/01/2022 |