Healthcare Provider Details

I. General information

NPI: 1548734429
Provider Name (Legal Business Name): KAYLA ALEXANDRIA GREENE MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 CLAIRMONT RD NE
BROOKHAVEN GA
30329-1015
US

IV. Provider business mailing address

3207 HENDERSON MILL RD APT T4
ATLANTA GA
30341-6019
US

V. Phone/Fax

Practice location:
  • Phone: 470-241-1353
  • Fax: 317-520-8200
Mailing address:
  • Phone: 352-246-4640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-33976
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: