Provider Demographics
NPI:1154670727
Name:KEATON, MOLLY ELIZABETH
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:KEATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 HIGHWAY 441 S
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-5454
Mailing Address - Country:US
Mailing Address - Phone:706-212-0581
Mailing Address - Fax:706-212-0143
Practice Address - Street 1:355 HIGHWAY 441 S
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-5454
Practice Address - Country:US
Practice Address - Phone:706-212-0581
Practice Address - Fax:706-212-0143
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13563183500000X
GA25942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist