Healthcare Provider Details

I. General information

NPI: 1922536937
Provider Name (Legal Business Name): KEELAND BANKHEAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2017
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

910 DEERFIELD CROSSING DR APT 13102
ALPHARETTA GA
30004-1834
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-8917
  • Fax:
Mailing address:
  • Phone: 803-627-1506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number88220
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: