Individual
JOHN A KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
108 NORTH PARK DR, FAYETTEVILLE, GA 30214
(770) 461-3466
(770) 461-3884
Mailing address
108 NORTH PARK DR, FAYETTEVILLE, GA 30214
(770) 461-3466
(770) 461-3884
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
00007369
AL
174400000X
Specialist
20555
GA
207Q00000X
Family Medicine Physician
Primary
20555
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52144193
BCBS OF GA
GA
Enumeration date
03/24/2006
Last updated
03/10/2016
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