Provider Demographics
NPI:1306032198
Name:KEITH, NABIL (MD)
Entity Type:Individual
Prefix:
First Name:NABIL
Middle Name:
Last Name:KEITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 NORTHSIDE DAWSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6227
Mailing Address - Country:US
Mailing Address - Phone:706-216-4444
Mailing Address - Fax:706-429-1140
Practice Address - Street 1:150 NORTHSIDE DAWSON DR
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6227
Practice Address - Country:US
Practice Address - Phone:706-216-4444
Practice Address - Fax:706-429-1140
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA068226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517494Medicaid