Provider Demographics
NPI:1083672216
Name:MCKEOWN, RICK DARR (MD)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:DARR
Last Name:MCKEOWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 CLAIRMONT RD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1015
Mailing Address - Country:US
Mailing Address - Phone:404-982-9992
Mailing Address - Fax:404-982-9965
Practice Address - Street 1:3101 CLAIRMONT RD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-1015
Practice Address - Country:US
Practice Address - Phone:404-982-9992
Practice Address - Fax:404-982-9965
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025636174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA30BDJMFMedicare ID - Type Unspecified
GAE70221Medicare UPIN