Individual
MRS. KELLY O'KEEFE-WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
512 S MAIN ST, HINESVILLE, GA 31313-4325
(912) 369-5437
Mailing address
512 S MAIN ST, HINESVILLE, GA 31313-4325
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5849
GA
363A00000X
Physician Assistant
PA.712
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003105013
—
GA
05
—
170095
—
AL
01
—
20297I6144
MEDICARE PTAN
GA
Enumeration date
07/05/2010
Last updated
04/07/2022
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