Provider Demographics
NPI:1730108846
Name:SUE-LING, KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:SUE-LING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KEITH
Other - Middle Name:
Other - Last Name:SUE-LING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1349 DRUID PARK AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904
Mailing Address - Country:US
Mailing Address - Phone:706-733-7537
Mailing Address - Fax:706-733-2774
Practice Address - Street 1:1349 DRUID PARK AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904
Practice Address - Country:US
Practice Address - Phone:706-733-7537
Practice Address - Fax:706-733-2774
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA21825207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00203794Medicaid
GA00203794Medicaid
D30944Medicare UPIN