Individual
DR. KEITH JAMES FALLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
1100 GREEN ST SW, CONYERS, GA 30012-5220
(404) 502-5824
Mailing address
PO BOX 1790, CONYERS, GA 30012-7964
(404) 502-5824
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY002856
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
375822929A
—
GA
05
—
375822929B
—
GA
Enumeration date
01/16/2007
Last updated
01/21/2015
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