Provider Demographics
NPI:1669475943
Name:KEATON WILLIAMS, ROTONDA (PA)
Entity Type:Individual
Prefix:MRS
First Name:ROTONDA
Middle Name:
Last Name:KEATON WILLIAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1100 JOHNSON FERRY RD NE
Mailing Address - Street 2:SUITE510
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1709
Mailing Address - Country:US
Mailing Address - Phone:404-419-1165
Mailing Address - Fax:404-419-1164
Practice Address - Street 1:1498 KLONDIKE RD SW
Practice Address - Street 2:SUITE 106
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5169
Practice Address - Country:US
Practice Address - Phone:770-761-7260
Practice Address - Fax:678-413-1818
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2011-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA004174363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97WCHDWMedicare PIN
GAQ58703Medicare UPIN