Keith Lennell McRae, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

010047 Issued in GA

Practice address

416 Broad St SE
Gainesville, GA 30501-3726

Phone

(770) 535-0445

Fax

(770) 535-2939

NPI assigned

Jan 13, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1168646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508917089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 BROAD ST SE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013726",
            "telephone_number": "770-535-0445",
            "fax_number": "770-535-2939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 BROAD ST SE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013726",
            "telephone_number": "770-535-0445",
            "fax_number": "770-535-2939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCRAE",
        "first_name": "KEITH",
        "middle_name": "LENNELL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "010047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00292608A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Noah McNeill
• Daniel McSpadden, COTA/L
• William H F McVey, PT, DPT
• Me Pivot Holdings LLC
• Christin Brooke Means, AUD.
• Lalitha C Medepalli, MD

• All providers in Gainesville, GA
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.