Provider Demographics
NPI:1457415846
Name:JOHN G. KEATING MD, PC
Entity Type:Organization
Organization Name:JOHN G. KEATING MD, PC
Other - Org Name:THE KEATING GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KEATING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-233-5252
Mailing Address - Street 1:3715 NORTHSIDE PKWY
Mailing Address - Street 2:BUILDING 400, SUITE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327
Mailing Address - Country:US
Mailing Address - Phone:404-233-5252
Mailing Address - Fax:404-233-0490
Practice Address - Street 1:3715 NORTHSIDE PKWY
Practice Address - Street 2:BUILDING 400, SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327
Practice Address - Country:US
Practice Address - Phone:404-233-5252
Practice Address - Fax:404-233-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024444174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00305907BMedicaid
GAD40327Medicare UPIN
GA00305907BMedicaid