Healthcare Provider Details

I. General information

NPI: 1205623170
Provider Name (Legal Business Name): ELIZABETH MCKEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 HIGHWAY 441 S
CLAYTON GA
30525-5425
US

IV. Provider business mailing address

168 ROGERS ST STE F
BLAIRSVILLE GA
30512-3621
US

V. Phone/Fax

Practice location:
  • Phone: 706-212-0349
  • Fax: 706-212-0349
Mailing address:
  • Phone: 678-349-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP273584
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: