Healthcare Provider Details

I. General information

NPI: 1902493315
Provider Name (Legal Business Name): KAYLA OATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MACON ST STE D
MCDONOUGH GA
30253-3233
US

IV. Provider business mailing address

10147 HEMLOCK WAY
JONESBORO GA
30238-8606
US

V. Phone/Fax

Practice location:
  • Phone: 678-831-7377
  • Fax:
Mailing address:
  • Phone: 404-451-1383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC010211
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-149544
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: