MEDICARE: KERI CASTLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1588554471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERI CASTLE

Provider Business Mailing Address
First Line	:	3545 WALDROP CLIFF CIR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-6742
Country	:	US
Telephone Number	:	678-777-6661
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 WALDROP CLIFF CIR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-6742
Country	:	US
Telephone Number	:	678-777-6661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2025
Last Update Date	:	07/03/2025

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Directions to “ KERI CASTLE ” Practice Location

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