Provider Demographics
NPI:1669873311
Name:L KEITH SIPSY DO PC
Entity type:Organization
Organization Name:L KEITH SIPSY DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:SIPSPY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:706-896-4673
Mailing Address - Street 1:103 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546-3223
Mailing Address - Country:US
Mailing Address - Phone:706-896-4673
Mailing Address - Fax:706-896-3992
Practice Address - Street 1:103 CHURCH ST
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546-3223
Practice Address - Country:US
Practice Address - Phone:706-896-4673
Practice Address - Fax:706-896-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty