Healthcare Provider Details

I. General information

NPI: 1316164288
Provider Name (Legal Business Name): JOHN STEWART KEELEY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN STEWART BEATTY

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3647 J DEWEY GRAY CIR STE 200
AUGUSTA GA
30909-2205
US

IV. Provider business mailing address

105 W STONE DR STE 6A
KINGSPORT TN
37660-3256
US

V. Phone/Fax

Practice location:
  • Phone: 706-504-9712
  • Fax: 706-504-9703
Mailing address:
  • Phone: 423-408-7220
  • Fax: 423-408-7405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number49812
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number68360
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD27894
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD27894
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number68360
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number49812
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: