NPI Code Detail JSON Logo

1316164288 NPI number — JOHN STEWART KEELEY JR. MD

NPI Number: 1316164288
Health Care Provider/Practitioner: JOHN STEWART KEELEY JR. MD

Information about “1316164288” NPI (JOHN STEWART KEELEY JR. MD) exists in 1316164288 in HTML format HTML  |  1316164288 in plain Text format TXT  |  1316164288 in PDF (Portable Document Format) PDF  |  1316164288 in an XML format XML  formats.

NPI Number : 1316164288 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1316164288",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KEELEY",
    "FirstName": "JOHN",
    "MiddleName": "STEWART",
    "NamePrefix": null,
    "NameSuffix": "JR.",
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BEATTY",
    "OtherFirstName": "JOHN",
    "OtherMiddleName": "STEWART",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "105 W STONE DR STE 6A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KINGSPORT",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37660-3256",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "423-408-7220",
    "MailingAddressFaxNumber": "423-408-7405",
    "FirstLinePracticeLocationAddress": "3647 J DEWEY GRAY CIR STE 200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AUGUSTA",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30909-2205",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "706-504-9712",
    "PracticeLocationAddressFaxNumber": "706-504-9703",
    "EnumerationDate": "04/20/2007",
    "LastUpdateDate": "05/13/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "49812",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "68360",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2086S0102X",
          "TaxonomyName": "Surgical Critical Care Physician",
          "LicenseNumber": "MD27894",
          "LicenseNumberStateCode": "ME",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "MD27894",
          "LicenseNumberStateCode": "ME",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "2086S0102X",
          "TaxonomyName": "Surgical Critical Care Physician",
          "LicenseNumber": "68360",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2086S0102X",
          "TaxonomyName": "Surgical Critical Care Physician",
          "LicenseNumber": "49812",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.