Provider Demographics
NPI:1245338177
Name:CAUSEY, KEITH EUGENE (PA)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:EUGENE
Last Name:CAUSEY
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:200 S ENOTA DR NE
Mailing Address - Street 2:STE 300
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3473
Mailing Address - Country:US
Mailing Address - Phone:770-219-7099
Mailing Address - Fax:
Practice Address - Street 1:200 S ENOTA DR NE
Practice Address - Street 2:STE 300
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3473
Practice Address - Country:US
Practice Address - Phone:770-219-7099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR75410001Medicare UPIN
GAR75410001Medicare UPIN