Healthcare Provider Details

I. General information

NPI: 1720659287
Provider Name (Legal Business Name): SKYLINE AUTISM SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 HIGHLAND PARC PL SE
MARIETTA GA
30067-2438
US

IV. Provider business mailing address

1818 HIGHLAND PARC PL SE
MARIETTA GA
30067-2438
US

V. Phone/Fax

Practice location:
  • Phone: 404-938-0720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHAVON HAYMER
Title or Position: OWNER
Credential: RBT
Phone: 404-938-0720