Provider Demographics
NPI:1104975002
Name:KEATING, WILLIAM JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:KEATING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1080 LUMPKIN CAMPGROUND RD S STE 300
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-0989
Mailing Address - Country:US
Mailing Address - Phone:706-203-1217
Mailing Address - Fax:706-265-4132
Practice Address - Street 1:1080 LUMPKIN CAMPGROUND RD S
Practice Address - Street 2:SUITE 300
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-0989
Practice Address - Country:US
Practice Address - Phone:706-265-4100
Practice Address - Fax:706-265-4132
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052971207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10050796OtherAMERIGROUP
GA325908OtherWELLCARE
GA000385310AMedicaid
GA08BBQGLMedicare PIN
E62904Medicare UPIN