Provider Demographics
NPI:1548686272
Name:KEATON, TINA S (NP-C)
Entity type:Individual
Prefix:MISS
First Name:TINA
Middle Name:S
Last Name:KEATON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:KEATON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:706-835-2235
Mailing Address - Fax:706-835-1706
Practice Address - Street 1:308 DEEP SOUTH FARM RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-2218
Practice Address - Country:US
Practice Address - Phone:706-835-2235
Practice Address - Fax:706-835-1706
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN107500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003144263A,B,DMedicaid
GA20250I2828Medicare PIN