Provider Demographics
NPI:1467451211
Name:SEIBERT, KEITH MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:MATTHEW
Last Name:SEIBERT
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 1:9390 FORD AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6418
Mailing Address - Country:US
Mailing Address - Phone:912-599-7075
Mailing Address - Fax:
Practice Address - Street 1:60 EXCHANGE ST STE B7
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7646
Practice Address - Country:US
Practice Address - Phone:912-756-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051733208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA010183OtherBCBS
SCG51733Medicaid
GA370021486OtherRR MEDICARE
GA000966897AMedicaid
GA000966897BMedicaid
GA010183OtherBCBS
GA000966897AMedicaid