Individual
DR. CORETTA D. KEITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP, FNP-BC
Contact information
Practice address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 382-7120
Mailing address
116 BEOWULF LN, LEESBURG, GA 31763-5831
(404) 710-6646
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN124581
GA
363LF0000X
Family Nurse Practitioner
AP4450
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000927198E
—
GA
01
—
P00266428
RAILROAD MEDICARE
GA
Enumeration date
06/03/2006
Last updated
05/04/2021
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