Provider Demographics
NPI:1528227972
Name:KEADLE, HOMER HAYGOOD III (MD)
Entity type:Individual
Prefix:DR
First Name:HOMER
Middle Name:HAYGOOD
Last Name:KEADLE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:KEADLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-1038
Mailing Address - Country:US
Mailing Address - Phone:706-649-6600
Mailing Address - Fax:706-649-6614
Practice Address - Street 1:920 18TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1524
Practice Address - Country:US
Practice Address - Phone:706-649-6600
Practice Address - Fax:706-649-6614
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0709932086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery