Provider Demographics
NPI:1457925067
Name:KEATON, MARSHELL
Entity Type:Individual
Prefix:
First Name:MARSHELL
Middle Name:
Last Name:KEATON
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 1:450 STONEWALL ST SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30313-1399
Mailing Address - Country:US
Mailing Address - Phone:229-322-0017
Mailing Address - Fax:
Practice Address - Street 1:75 PIEDMONT AVE NE STE 907
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2571
Practice Address - Country:US
Practice Address - Phone:404-420-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health