Keenan, Mark William
Keenan, Mark William is an individual health care provider with primary practice located at 770 Pine St Ste 290 Attn: Radiology Department, Macon GA 31201-7516. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Keenan, Mark William can be contacted via phone (478) 743-1458.Contact Information
Primary practice address
770 Pine St Ste 290 Attn: Radiology Department
Macon GA 31201-7516
Phone: (478) 743-1458
Fax: (478) 755-1332
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 40436 | Georgia |
Profile Details
| NPI number | 1932199742 |
|---|---|
| LBN Legal business name | Keenan, Mark William |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 24th, 2005 |
| Last updated | Jul 3rd, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1932199742 | NPPES |
| Georgia | MEDICAID | 000817341B |
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