Basic Information
| Provider Information | |||||||||
| NPI: | 1164596094 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIS R KEENE MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 N GROSS RD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | KINGSLAND | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127297332 | ||||||||
| FaxNumber: | 9127294307 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 N GROSS RD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | KINGSLAND | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127297332 | ||||||||
| FaxNumber: | 9127294307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KEENE | ||||||||
| AuthorizedOfficialFirstName: | WILLLIS | ||||||||
| AuthorizedOfficialMiddleName: | RIGGS | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9127297332 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207RH0000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
No ID Information.