MEDICARE: DOUGLAS CHARLES KEITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	30184	NC

General Provider Information

NPI Number	:	1063444198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS CHARLES KEITH MD

Provider Business Mailing Address
First Line	:	PO BOX 187
Second Line	:
City	:	FAISON
State	:	NC
Zip	:	28341-0187
Country	:	US
Telephone Number	:	910-267-2042
Fax Number	:	855-996-9090

Provider Business Practice Location Address
First Line	:	104A ADAIR DR
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27530-4516
Country	:	US
Telephone Number	:	919-648-4435
Fax Number	:	910-356-2311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	04/23/2025

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