Individual
KEITH BACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5658 REX RIDGE LOOP, REX, GA 30273-5237
(404) 849-9419
(678) 586-3370
Mailing address
5658 REX RIDGE LOOP, REX, GA 30273-5237
(404) 849-9419
(678) 586-3370
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
BL-001113-2019
GA
Other
Enumeration date
09/10/2019
Last updated
09/17/2021
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