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General NPI Number Information
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NPI Number | 1144959131
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Entity Type | Individual
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Provider Name | MICHAEL MCKEIGHEN MD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2022
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 1459 LANEY WALKER BLVD
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City | AUGUSTA
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State | GA
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Zip | 30912-0002
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Country | US
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Telephone | 843-593-5430
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Fax |
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Provider Business Mailing Address
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Address Line | 205 BASINGHOUSE RD
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City | COLUMBIA
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State | SC
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Zip | 29212-1048
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Country | US
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Telephone | 843-593-5430
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number | 13826
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License Number State | GA
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