Healthcare Provider Details

I. General information

NPI: 1457211880
Provider Name (Legal Business Name): KAMRYN LEAH PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 ALEXANDER DR
AUGUSTA GA
30909-2202
US

IV. Provider business mailing address

1062 ALEXANDER DR
AUGUSTA GA
30909-2202
US

V. Phone/Fax

Practice location:
  • Phone: 706-955-7687
  • Fax: 706-535-3596
Mailing address:
  • Phone: 706-955-7687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-491230
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: