Healthcare Provider Details

I. General information

NPI: 1245795442
Provider Name (Legal Business Name): MS. KYLA ZENOBIA HAWKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 LODGEPOLE CT
DOUGLASVILLE GA
30135-8218
US

IV. Provider business mailing address

500 FAIRWAY DR STE 102
DEERFIELD BEACH FL
33441-1817
US

V. Phone/Fax

Practice location:
  • Phone: 470-597-1149
  • Fax:
Mailing address:
  • Phone: 888-880-9270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: