Provider Demographics
NPI:1184769085
Name:KEELEY, DONALD LEONARD (PHD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LEONARD
Last Name:KEELEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 PEACHTREE ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:404-872-1860
Mailing Address - Fax:404-609-9044
Practice Address - Street 1:1720 PEACHTREE ST SUITE 420
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-872-1860
Practice Address - Fax:404-609-9044
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA726103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R61480Medicare UPIN