Provider Demographics
NPI:1629095369
Name:PARMER, KEITH M (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:M
Last Name:PARMER
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 1:701 RUSTIC RIDGE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-8676
Mailing Address - Country:US
Mailing Address - Phone:770-709-3593
Mailing Address - Fax:
Practice Address - Street 1:1501 SHORTER AVE SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-3964
Practice Address - Country:US
Practice Address - Phone:706-291-0584
Practice Address - Fax:706-290-0849
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00192453GMedicaid
GAD30416Medicare UPIN