Individual
JONATHAN LATRELL KEITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2020 REMOUNT RD STE E112, GASTONIA, NC 28054-7476
(704) 451-3878
Mailing address
12109 PRAILS MILL LN, CHARLOTTE, NC 28262-1586
(704) 451-3878
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
M2024-11283-01
NC
Other
Enumeration date
02/08/2024
Last updated
02/08/2024
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