Provider Demographics
NPI:1154532331
Name:REDDICK, KEISHA LB (MD)
Entity type:Individual
Prefix:DR
First Name:KEISHA
Middle Name:LB
Last Name:REDDICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6268
Mailing Address - Country:US
Mailing Address - Phone:912-350-5970
Mailing Address - Fax:912-350-3374
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-350-5970
Practice Address - Fax:912-350-3374
Is Sole Proprietor?:No
Enumeration Date:2007-05-27
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37501207VM0101X
NC2007-00868207VM0101X
GA071860207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP01321567OtherRAILROAD MEDICARE
GA003146294BMedicaid
GA003146294AMedicaid
SCQ68007Medicaid
GAP01321567OtherRAILROAD MEDICARE
GA003146294AMedicaid
SCQ68007Medicaid