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1316164288

NPI Code Detail

MEDICARE: JOHN STEWART KEELEY JR. MD

MEDICARE: JOHN STEWART KEELEY JR. 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	208600000X	Surgery Physician	49812	TN
2	208600000X	Surgery Physician	68360	GA
3	2086S0102X	Surgical Critical Care Physician	MD27894	ME
4	208600000X	Surgery Physician	MD27894	ME
5	2086S0102X	Surgical Critical Care Physician	68360	GA
6	2086S0102X	Surgical Critical Care Physician	49812	TN

General Provider Information

NPI Number	:	1316164288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN STEWART KEELEY JR. MD

Provider Business Mailing Address
First Line	:	105 W STONE DR STE 6A
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37660-3256
Country	:	US
Telephone Number	:	423-408-7220
Fax Number	:	423-408-7405

Provider Business Practice Location Address
First Line	:	3647 J DEWEY GRAY CIR STE 200
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-2205
Country	:	US
Telephone Number	:	706-504-9712
Fax Number	:	706-504-9703

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	05/13/2024

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Directions to “ JOHN STEWART KEELEY JR. MD” Practice Location

Language	Start Address	Practice Location

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