Provider Demographics
NPI:1487799771
Name:KEEM SPINE INSTITUTE, P.C
Entity type:Organization
Organization Name:KEEM SPINE INSTITUTE, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-277-9222
Mailing Address - Street 1:753 OLD NORCROSS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4312
Mailing Address - Country:US
Mailing Address - Phone:770-277-9222
Mailing Address - Fax:770-817-0186
Practice Address - Street 1:753 OLD NORCROSS RD
Practice Address - Street 2:SUITE B
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4312
Practice Address - Country:US
Practice Address - Phone:770-277-9222
Practice Address - Fax:770-817-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA49239174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20BBFRCMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER