Healthcare Provider Details

I. General information

NPI: 1659142438
Provider Name (Legal Business Name): SKYLA MOODY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451B US HIGHWAY 17
RICHMOND HILL GA
31324-3397
US

IV. Provider business mailing address

3812 FENWICK VILLAGE DR
SAVANNAH GA
31419-5502
US

V. Phone/Fax

Practice location:
  • Phone: 615-560-6622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA003117
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: