Healthcare Provider Details

I. General information

NPI: 1063444198
Provider Name (Legal Business Name): DOUGLAS CHARLES KEITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104A ADAIR DR
GOLDSBORO NC
27530-4516
US

IV. Provider business mailing address

PO BOX 187
FAISON NC
28341-0187
US

V. Phone/Fax

Practice location:
  • Phone: 919-648-4435
  • Fax: 910-356-2311
Mailing address:
  • Phone: 910-267-2042
  • Fax: 855-996-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number30184
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: