NPIMap

Organization Active NPI

John a Keller, MD, PC

Doing business as Fayetteville Family Practice

  • Adult Medicine Physician
  • Fayetteville, GA
National Provider Identifier
1407989155
Registry record updated Apr 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
020555 Issued in GA
Legal business name
JOHN A KELLER, MD, PC
Doing business as
Fayetteville Family Practice
Practice address
108 N Park Dr
Fayetteville, GA 30214-1645
Phone
(770) 461-3466
NPI assigned
Mar 13, 2007
Last updated
Apr 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. John Keller, M.D.NPI 1962462937
Title
President
Phone
(770) 461-3466

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QA0505X 020555 GA Primary

Addresses

Primary practice location

108 N Park Dr
Fayetteville, GA 30214-1645

Mailing address

108 N Park Dr
Fayetteville, GA 30214-1645
Phone (770) 461-3466

Other names 1

  • FAYETTEVILLE FAMILY PRACTICE Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461110400000",
    "number": "1407989155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 N PARK DR",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141645",
            "telephone_number": "770-461-3466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 N PARK DR",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141645",
            "telephone_number": "770-461-3466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN A KELLER, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2016-04-20",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-461-3466",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "GA",
            "license": "020555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAYETTEVILLE FAMILY PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.