Provider Demographics
NPI:1437155777
Name:RICE, JAMES 'KEITH' (PA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:'KEITH'
Last Name:RICE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:J.
Other - Middle Name:KEITH
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1700 HOSPITAL SOUTH DR
Mailing Address - Street 2:STE 300
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8116
Mailing Address - Country:US
Mailing Address - Phone:770-944-2830
Mailing Address - Fax:678-581-7170
Practice Address - Street 1:100 MARKET PLACE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-8718
Practice Address - Country:US
Practice Address - Phone:770-386-7253
Practice Address - Fax:770-382-6424
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003848363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA595180154BMedicaid
GA595180154AMedicaid
GA595180154BMedicaid
GA595180154AMedicaid