MEDICARE: JOHN G. KEATING MD, PC

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	174400000X	Specialist	024444	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

General Provider Information

NPI Number	:	1457415846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN G. KEATING MD, PC

Provider Business Mailing Address
First Line	:	3715 NORTHSIDE PKWY
Second Line	:	BUILDING 400, SUITE 150
City	:	ATLANTA
State	:	GA
Zip	:	30327
Country	:	US
Telephone Number	:	404-233-5252
Fax Number	:	404-233-0490

Provider Business Practice Location Address
First Line	:	3715 NORTHSIDE PKWY
Second Line	:	BUILDING 400, SUITE 150
City	:	ATLANTA
State	:	GA
Zip	:	30327
Country	:	US
Telephone Number	:	404-233-5252
Fax Number	:	404-233-0490

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN G KEATING
Credential	:	M.D.
Telephone Number	:	404-233-5252

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	06/24/2013

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