Provider Demographics
NPI:1164596094
Name:WILLIS R KEENE MD PC
Entity Type:Organization
Organization Name:WILLIS R KEENE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLLIS
Authorized Official - Middle Name:RIGGS
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:912-729-7332
Mailing Address - Street 1:130 N GROSS RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548
Mailing Address - Country:US
Mailing Address - Phone:912-729-7332
Mailing Address - Fax:912-729-4307
Practice Address - Street 1:130 N GROSS RD
Practice Address - Street 2:SUITE 205
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548
Practice Address - Country:US
Practice Address - Phone:912-729-7332
Practice Address - Fax:912-729-4307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
897Medicare ID - Type Unspecified