Basic Information
| Provider Information | |||||||||
| NPI: | 1528020500 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEATS | ||||||||
| FirstName: | GRAHAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 213 WAGON DR | ||||||||
| Address2: | |||||||||
| City: | BRACEY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 239192955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858207801 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1755 N MECKLENBURG AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH HILL | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4344473151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101259876 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208D00000X | 0101259876 | VA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.