MEDICARE: MR. KEITH MAAS CSFA

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	246ZC0007X	Surgical Assistant	132146	VA

General Provider Information

NPI Number	:	1932468410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEITH MAAS CSFA

Provider Business Mailing Address
First Line	:	PO BOX 2550
Second Line	:
City	:	ROWLETT
State	:	TX
Zip	:	75030-2550
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

Provider Business Practice Location Address
First Line	:	1415 HIGHWAY 85 N STE 310-147
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-7738
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

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

Provider Enumeration Date	:	05/03/2012
Last Update Date	:	12/06/2021

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