Christopher Timothy Keenan, D.D.S

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

DN013152 Issued in GA

Practice address

64 Stockade Rd
Summerville, GA 30747-1900

Phone

(706) 857-2323

Fax

(706) 857-7041

NPI assigned

Aug 15, 2005

Last updated

Nov 14, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194998400000",
    "number": "1962404301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 RIVER RUSH DR",
            "city": "SUGAR HILL",
            "state": "GA",
            "postal_code": "305187462",
            "telephone_number": "770-826-7710",
            "fax_number": "706-857-7041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 STOCKADE RD",
            "city": "SUMMERVILLE",
            "state": "GA",
            "postal_code": "307471900",
            "telephone_number": "706-857-2323",
            "fax_number": "706-857-7041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEENAN",
        "first_name": "CHRISTOPHER",
        "middle_name": "TIMOTHY",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2007-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "GA",
            "license": "DN013152",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN013152",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adaobi N Ibeabuchi
• Jackson Drug Co., Inc
• Joel K. Jager, M.D.
• Jenna Spencer
• Johnson RX Inc (Summerville Discount Pharmacy)
• Amanda Key, COTA/L
• Luanne Thomas Kilgo, OTR/L
• Weston King, M.D.
• Lisa Renee Kirkpatrick, MS, OTR/L
• Sonya Meleia Koshute, PTA

• Public Health Dentistry in Summerville, GA
• Providers in Summerville, GA by specialty
• Public Health Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.