Provider Demographics
NPI:1437824299
Name:TURNER, KEAIRAH
Entity type:Individual
Prefix:
First Name:KEAIRAH
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3368 ASBURY SQ
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30346-2419
Mailing Address - Country:US
Mailing Address - Phone:678-749-3191
Mailing Address - Fax:
Practice Address - Street 1:5825 GLENRIDGE DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5387
Practice Address - Country:US
Practice Address - Phone:678-733-9318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-21-159960106S00000X
GA1-23-70353103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician