Provider Demographics
NPI:1467406983
Name:KELLER, CRYMES, & DEMARCO LLC
Entity Type:Organization
Organization Name:KELLER, CRYMES, & DEMARCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-549-9993
Mailing Address - Street 1:105 TRINITY PL.
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-2112
Mailing Address - Country:US
Mailing Address - Phone:706-549-9993
Mailing Address - Fax:706-549-4047
Practice Address - Street 1:105 TRINITY PL.
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-2112
Practice Address - Country:US
Practice Address - Phone:706-549-9993
Practice Address - Fax:706-549-4047
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KELLER, CRYMES, & DEMARCO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-20
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300031703AMedicaid
GAGRP4438Medicare ID - Type UnspecifiedGROUP NUMBER