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Individual

BRIAN KEITH KELLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
435 N CEDAR ST, SUMMERVILLE, SC 29483-6407
(843) 873-1592
(843) 507-8284
Mailing address
PO BOX 530062, ATLANTA, GA 30353-0062
(843) 695-6071
(843) 569-5879

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18014
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
080163302
MEDICARE RAIL ROAD
SC
05
180146
SC
Enumeration date
04/27/2006
Last updated
06/29/2021
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