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NPI Code Detail

MEDICARE: DAEGEON ROBERTSON

MEDICARE: DAEGEON ROBERTSON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1841143393
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAEGEON ROBERTSON
Provider Business Mailing Address
First Line : 3070 BUSINESS PARK DR STE B
Second Line :
City : NORCROSS
State : GA
Zip : 30071-1428
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3070 BUSINESS PARK DR STE B
Second Line :
City : NORCROSS
State : GA
Zip : 30071-1428
Country : US
Telephone Number : 770-884-1050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2026
Last Update Date : 02/16/2026

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Directions to “ DAEGEON ROBERTSON ” Practice Location

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