Provider Demographics
NPI:1598971780
Name:MOUNTAIN EAST FAMILY MEDICINE PC
Entity type:Organization
Organization Name:MOUNTAIN EAST FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:T
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:770-921-6900
Mailing Address - Street 1:4120 FIVE FORKS TRICKUM RD SW
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3130
Mailing Address - Country:US
Mailing Address - Phone:770-921-6900
Mailing Address - Fax:770-921-6313
Practice Address - Street 1:4120 FIVE FORKS TRICKUM RD SW
Practice Address - Street 2:SUITE 105
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3130
Practice Address - Country:US
Practice Address - Phone:770-921-6900
Practice Address - Fax:770-921-6313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty