Healthcare Provider Details

I. General information

NPI: 1912837113
Provider Name (Legal Business Name): WESTON KEPHART RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 N DRUID HILLS RD NE STE 280
ATLANTA GA
30329-3141
US

IV. Provider business mailing address

2250 N DRUID HILLS RD NE STE 280
ATLANTA GA
30329-3141
US

V. Phone/Fax

Practice location:
  • Phone: 404-282-8846
  • Fax: 470-604-9792
Mailing address:
  • Phone: 404-282-8846
  • Fax: 470-604-9792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-382810
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: