Healthcare Provider Details

I. General information

NPI: 1063487015
Provider Name (Legal Business Name): ALAN M. KEATING PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 HIGHWAY 81
LOGANVILLE GA
30052-9112
US

IV. Provider business mailing address

1765 OLD WEST BROAD ST BLDG 2-200
ATHENS GA
30606-2887
US

V. Phone/Fax

Practice location:
  • Phone: 770-554-5009
  • Fax: 706-546-8792
Mailing address:
  • Phone: 706-549-1663
  • Fax: 706-549-1663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2995
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: