Healthcare Provider Details

I. General information

NPI: 1871913111
Provider Name (Legal Business Name): DWAIN KESTON EMBURLIE ROBERTSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 DOWNWOOD CIR NW STE 700
ATLANTA GA
30327-5308
US

IV. Provider business mailing address

3200 DOWNWOOD CIR NW STE 700
ATLANTA GA
30327-5308
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-0743
  • Fax: 855-590-3792
Mailing address:
  • Phone: 404-355-0743
  • Fax: 855-590-3792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberQ9896
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number90418
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: