IndividualActive
Mark Keen
NPI 1578310652 · Home Modifications Contractor · Evans, GA
Provider details
- NPI number
- 1578310652
- Entity type
- Individual
- Primary specialty
- Home Modifications ContractorOther Service Providers
- Sex
- Male
- Sole proprietor
- Yes
- License
- 84-4617478 (GA)
Specialties & taxonomies
Other Service Providers
Practice location
515 Fairfield Way
Evans, GA 30809-3619
Phone: (786) 715-7845
Approximate (ZIP-level) locationGet directions
Mailing address
515 Fairfield Way
Evans, GA 30809-3619
Registry dates
- Enumerated
- 2024-05-06
- Last updated
- 2024-05-06
- Certified
- 2024-05-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.