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General NPI Number Information
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NPI Number | 1376496976
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Entity Type | Individual
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Provider Name | JOHNNIE KEO
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Gender | Male
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Dates
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Enumeration Date | 02/16/2026
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 1125 TOWNE CENTRE VILLAGE DRIVE
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City | MCDONOUGH
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State | GA
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Zip | 30253
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Country | US
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Telephone | 678-583-6560
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 GADWALL LN
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-4480
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Country | US
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Telephone | 470-636-8888
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH030148
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License Number State | GA
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