Healthcare Provider Details

I. General information

NPI: 1568154912
Provider Name (Legal Business Name): SAVANNAH JUNE KEFFER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/24/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 N JEFFERSON ST
LEWISBURG WV
24901
US

IV. Provider business mailing address

78 UTTERBACK DR
ALDERSON WV
24910-4509
US

V. Phone/Fax

Practice location:
  • Phone: 304-645-3220
  • Fax: 304-647-1273
Mailing address:
  • Phone: 304-640-4767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: