Healthcare Provider Details

I. General information

NPI: 1295664167
Provider Name (Legal Business Name): KYLIE DAYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 PARKSIDE VILLAGE WAY NW
MARIETTA GA
30060-7956
US

IV. Provider business mailing address

623 PARKSIDE VILLAGE WAY NW
MARIETTA GA
30060-7956
US

V. Phone/Fax

Practice location:
  • Phone: 205-837-2559
  • Fax:
Mailing address:
  • Phone: 205-837-2559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: