Individual
MS. KEELY DIANNE SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1014 FORSYTH ST, STE 300, MACON, GA 31201-2025
(478) 633-8700
(478) 633-8710
Mailing address
556 3RD ST, STE A, MACON, GA 31201-7993
(478) 743-2472
(478) 743-1516
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/19/2008
Last updated
01/17/2020
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