Provider Demographics
NPI:1215811948
Name:KEITHAN, GEORGE III
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:KEITHAN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HIDDEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HIGGANUM
Mailing Address - State:CT
Mailing Address - Zip Code:06441-4502
Mailing Address - Country:US
Mailing Address - Phone:860-510-1157
Mailing Address - Fax:
Practice Address - Street 1:599 FARMINGTON AVE STE 202
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2383
Practice Address - Country:US
Practice Address - Phone:860-837-5170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10.188585163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse