Healthcare Provider Details

I. General information

NPI: 1154255446
Provider Name (Legal Business Name): DR. KEENAN C. SWEENEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

500 VIKING DR APT 5301
AUGUSTA GA
30909-4971
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number111948
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: