Provider Demographics
NPI:1356545289
Name:KEATING, JOHN G (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:KEATING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4035 WHITEWATER CREEK RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-3946
Mailing Address - Country:US
Mailing Address - Phone:404-262-9161
Mailing Address - Fax:404-233-0490
Practice Address - Street 1:3715 NORTHSIDE PKWY NW
Practice Address - Street 2:BUILDING 400 SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2806
Practice Address - Country:US
Practice Address - Phone:404-233-5252
Practice Address - Fax:404-233-0490
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00305907BMedicaid
GA00305907BMedicaid
GA20BDBGCMedicare ID - Type Unspecified