Individual
JOHNATHAN P KEENUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5901-B PEACHTREE DUNWOODY RD, SUITE B-420, ATLANTA, GA 30328
(256) 627-9518
Mailing address
1438 CANOOCHEE DR NE, BROOKHAVEN, GA 30319-3456
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
76392
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2010
Last updated
09/09/2016
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