Individual
MR. KEITH W MUNOZ SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
100 S MADISON ST, THOMASVILLE, GA 31792-5473
(229) 236-0831
(229) 236-0871
Mailing address
PO BOX 1276, THOMASVILLE, GA 31799-1276
(229) 236-0831
(229) 236-0871
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004279
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
083704148
TRICARE
GA
05
—
299512679C
—
GA
01
—
P001145189
RAILROAD
GA
Enumeration date
06/15/2006
Last updated
06/13/2013
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