Active NPI
Chandler P Keown
- Behavior Technician
- Kennesaw, GA
National Provider Identifier
1366282535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 106S00000X
- Practice address
- 1000 Cobb Place Blvd NW Ste 230
Kennesaw, GA 30144-3684 - Phone
- (470) 648-3280
- NPI assigned
- May 27, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 106S00000X | GA | Primary |
Addresses
Primary practice location
1000 Cobb Place Blvd NW Ste 230
Kennesaw, GA 30144-3684
Mailing address
591 Mountainbrooke Cir
Stone Mountain, GA 30087-2867
Phone (678) 900-3839
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 106S00000X | GA | MD | Rehabilitation Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716768000000",
"number": "1366282535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "591 MOUNTAINBROOKE CIR",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300872867",
"telephone_number": "678-900-3839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 COBB PLACE BLVD NW STE 230",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301443684",
"telephone_number": "470-648-3280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEOWN",
"first_name": "CHANDLER",
"middle_name": "P",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-27",
"last_updated": "2024-05-27",
"certification_date": "2024-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "GA",
"license": "106S00000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.