Healthcare Provider Details

I. General information

NPI: 1952545287
Provider Name (Legal Business Name): KEISHAUN SASCHIER PROCTOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 CASCADE RD SW STE S
ATLANTA GA
30331-2146
US

IV. Provider business mailing address

868 YORK AVE SW
ATLANTA GA
30310-2750
US

V. Phone/Fax

Practice location:
  • Phone: 404-699-1339
  • Fax:
Mailing address:
  • Phone: 404-752-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number67962
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: