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NPI Code Detail

MEDICARE: MS. KIMBERLY SUSAN KEYES PA

MEDICARE: MS. KIMBERLY SUSAN KEYES 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
1363AM0700XMedical Physician AssistantPA5363GA

General Provider Information

NPI Number : 1700819828
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLY SUSAN KEYES PA
Provider Business Mailing Address
First Line : 5949 BUFORD HWY
Second Line :
City : NORCROSS
State : GA
Zip : 30071-2472
Country : US
Telephone Number : 678-280-6630
Fax Number : 648-280-6635
Provider Business Practice Location Address
First Line : 355 ABBOTT ST STE 100
Second Line :
City : SALINAS
State : CA
Zip : 93901-4484
Country : US
Telephone Number : 831-751-7070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2006
Last Update Date : 12/06/2023

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