Provider Demographics
NPI:1366325201
Name:LATHEM, ROBERT TAYLOR (BCBA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:TAYLOR
Last Name:LATHEM
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 HOLLY SPRINGS PKWY APT 3207
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-7473
Mailing Address - Country:US
Mailing Address - Phone:678-756-6175
Mailing Address - Fax:
Practice Address - Street 1:13000 DEERFIELD PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6119
Practice Address - Country:US
Practice Address - Phone:404-446-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst