Provider Demographics
NPI:1598950057
Name:DAWSONVILLE FAMILY MEDICINE
Entity Type:Organization
Organization Name:DAWSONVILLE FAMILY MEDICINE
Other - Org Name:KEATING FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEATING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-265-4100
Mailing Address - Street 1:1080 LUMPKIN CAMPGROUND RD S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-0989
Mailing Address - Country:US
Mailing Address - Phone:706-265-4100
Mailing Address - Fax:706-265-4132
Practice Address - Street 1:1080 LUMPKIN CAMPGROUND RD S
Practice Address - Street 2:SUITE 300
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-0989
Practice Address - Country:US
Practice Address - Phone:706-265-4100
Practice Address - Fax:706-265-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052971207Q00000X, 207QA0401X
GA058360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA384386095CMedicaid
GA00385310AMedicaid
GA511I110200Medicare PIN
GA08BBQGLMedicare PIN