Healthcare Provider Details

I. General information

NPI: 1013848068
Provider Name (Legal Business Name): LYLA MURRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 LEEFIELD STATION RD
BROOKLET GA
30415-6084
US

IV. Provider business mailing address

1327 LEEFIELD STATION RD
BROOKLET GA
30415-6084
US

V. Phone/Fax

Practice location:
  • Phone: 912-704-8368
  • Fax:
Mailing address:
  • Phone: 912-704-8368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1460830
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: