Provider Demographics
NPI:1205924388
Name:KERR, ROBY MORTON (MSW, PHD)
Entity type:Individual
Prefix:DR
First Name:ROBY
Middle Name:MORTON
Last Name:KERR
Suffix:
Gender:M
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 MULBERRY ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-6715
Mailing Address - Country:US
Mailing Address - Phone:478-745-3314
Mailing Address - Fax:478-308-7010
Practice Address - Street 1:830 MULBERRY ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6715
Practice Address - Country:US
Practice Address - Phone:478-745-3314
Practice Address - Fax:478-308-7010
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBDVNMedicare ID - Type Unspecified