Healthcare Provider Details

I. General information

NPI: 1992169692
Provider Name (Legal Business Name): KEEGAN ANNE MICHEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N PATTERSON ST
VALDOSTA GA
31602-1735
US

IV. Provider business mailing address

655 W 8TH STREET, BOX C-506
JACKSONVILLE FL
32209
US

V. Phone/Fax

Practice location:
  • Phone: 229-245-6202
  • Fax:
Mailing address:
  • Phone: 904-244-3817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301118848
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number81765
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: