Provider Demographics
NPI:1922862606
Name:ANDERSON, KAYLA ASHLEY
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ASHLEY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 LIBERTY LN SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6279
Mailing Address - Country:US
Mailing Address - Phone:404-357-3716
Mailing Address - Fax:
Practice Address - Street 1:2202 LIBERTY LN SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6279
Practice Address - Country:US
Practice Address - Phone:404-357-3716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician