Provider Demographics
NPI:1851568273
Name:MCEWEN, KEISHA (MD)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:MCEWEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KEISHA
Other - Middle Name:D
Other - Last Name:ENDSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:550 PEACHTREE ST NE STE 1220
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2237
Mailing Address - Country:US
Mailing Address - Phone:404-230-5622
Mailing Address - Fax:404-230-5623
Practice Address - Street 1:550 PEACHTREE ST NE STE 1220
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2237
Practice Address - Country:US
Practice Address - Phone:404-230-5622
Practice Address - Fax:404-230-5623
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67678207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003123344AMedicaid