Healthcare Provider Details

I. General information

NPI: 1275894826
Provider Name (Legal Business Name): TIMOTHY RICHARD KEY CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 EDENTON ESTATES DR
FAYETTEVILLE GA
30214-4442
US

IV. Provider business mailing address

115 EDENTON ESTATES DR
FAYETTEVILLE GA
30214-4442
US

V. Phone/Fax

Practice location:
  • Phone: 678-642-5360
  • Fax:
Mailing address:
  • Phone: 678-642-5360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: