Provider Demographics
NPI:1710044425
Name:NIAGER, KEITH EDWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:EDWARD
Last Name:NIAGER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16830
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-3530
Mailing Address - Country:US
Mailing Address - Phone:912-352-7638
Mailing Address - Fax:912-352-7492
Practice Address - Street 1:1 OGLETHORPE PROFESSIONAL BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-352-7638
Practice Address - Fax:912-352-7492
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALCSW0009731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00753244AMedicaid
GA8088DFMMedicare ID - Type Unspecified
GA00753244AMedicaid