Healthcare Provider Details

I. General information

NPI: 1144159989
Provider Name (Legal Business Name): KAYLA ANDERSON-WILLIAMS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RIVER ST
BAINBRIDGE GA
39817-3654
US

IV. Provider business mailing address

1442 JOHNNY FREEMAN RD
COLQUITT GA
39837-5737
US

V. Phone/Fax

Practice location:
  • Phone: 229-495-3005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-265211
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: