Individual provider Active NPI

Keith E. Hannay, M.D.

  • Family Medicine Physician
  • Rome, GA
National Provider Identifier
1730196452
Registry record updated Mar 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
025760 Issued in GA
Practice address
304 Shorter Ave NW
Suite 201
Rome, GA 30165-4290
Phone
(706) 509-3300
Fax
(706) 509-4596
NPI assigned
Aug 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 025760 GA Primary

Addresses

Primary practice location

304 Shorter Ave NW
Suite 201
Rome, GA 30165-4290

Mailing address

420 E 2ND Ave Ste 103
Rome, GA 30161-3210
Phone (706) 509-3000

Other identifiers 1

IdentifierTypeStateIssuer
00387802MMedicaidGA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address khannay913819@CarolinasHealthcareSystem.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100818000899 GA Practitioner - Family Practice 2365576972 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
025760GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Floyd Healthcare Management Inc Family Medicine CurrentSince Jan 1, 1998 Accepting new patients
Floyd Healthcare Management Inc CurrentSince Jan 1, 1998 Accepting new patients

Locations

1025 N Main St
Cedartown, GA 30125
Phone (770) 748-5212

330 Turner McCall Blvd SW
Ste 107
Rome, GA 30165
Phone (706) 509-6439

420 E 2nd Ave
Ste 103
Rome, GA 30161
Phone (706) 509-3278

304 Shorter Ave NW
Ste 201
Rome, GA 30165
Phone (706) 509-3300

Interoperability endpoints

  • Direct secure messaging: khannay913819@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678406400000",
    "number": "1730196452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 E 2ND AVE STE 103",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301613210",
            "telephone_number": "706-509-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 SHORTER AVE NW",
            "address_2": "SUITE 201",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301654290",
            "telephone_number": "706-509-3300",
            "fax_number": "706-509-4596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNAY",
        "first_name": "KEITH",
        "middle_name": "E.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "025760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00387802M",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "khannay913819@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "N",
            "address_1": "304 Shorter Ave NW",
            "address_2": "Suite 201",
            "city": "Rome",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301654290",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rome, GA

Sources for this page

Verify at the official NPI Registry.