Provider Demographics
NPI:1144733585
Name:KEATON, CHARSUEDE
Entity type:Individual
Prefix:
First Name:CHARSUEDE
Middle Name:
Last Name:KEATON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 LYNNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-6446
Mailing Address - Country:US
Mailing Address - Phone:229-400-3735
Mailing Address - Fax:
Practice Address - Street 1:134 LYNNWOOD DR
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-6446
Practice Address - Country:US
Practice Address - Phone:229-400-3735
Practice Address - Fax:229-400-3735
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services