Provider Demographics
NPI:1831315431
Name:WEEKS, KEELA K (NP)
Entity Type:Individual
Prefix:
First Name:KEELA
Middle Name:K
Last Name:WEEKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11050 CRABAPPLE RD
Mailing Address - Street 2:SUITE 104B
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2489
Mailing Address - Country:US
Mailing Address - Phone:770-645-0017
Mailing Address - Fax:770-645-0224
Practice Address - Street 1:11050 CRABAPPLE ROAD
Practice Address - Street 2:SUITE104 B
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075
Practice Address - Country:US
Practice Address - Phone:770-645-0017
Practice Address - Fax:770-645-0224
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I500272Medicare UPIN