Provider Demographics
NPI:1639491376
Name:KEIM, AMY JOYCE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JOYCE
Last Name:KEIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 HOLLY PL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8652
Mailing Address - Country:US
Mailing Address - Phone:678-927-0330
Mailing Address - Fax:
Practice Address - Street 1:122 HOLLY PL
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8652
Practice Address - Country:US
Practice Address - Phone:678-927-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist