MEDICARE: MR. JAMES 'KEITH' RICE PA

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	363AM0700X	Medical Physician Assistant	003848	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437155777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES 'KEITH' RICE PA

Provider Business Mailing Address
First Line	:	1700 HOSPITAL SOUTH DR
Second Line	:	STE 300
City	:	AUSTELL
State	:	GA
Zip	:	30106-8116
Country	:	US
Telephone Number	:	770-944-2830
Fax Number	:	678-581-7170

Provider Business Practice Location Address
First Line	:	100 MARKET PLACE BLVD
Second Line	:	SUITE 200
City	:	CARTERSVILLE
State	:	GA
Zip	:	30121-8718
Country	:	US
Telephone Number	:	770-386-7253
Fax Number	:	770-382-6424

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2008

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