Healthcare Provider Details

I. General information

NPI: 1225940265
Provider Name (Legal Business Name): KIMBERLY TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 DELAUNEY AVE STE 201A
COLUMBUS GA
31901-2367
US

IV. Provider business mailing address

4144 MARA VISTA DR
AUBURN AL
36832-1524
US

V. Phone/Fax

Practice location:
  • Phone: 706-221-2194
  • Fax:
Mailing address:
  • Phone: 706-221-2194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-531240
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: