Healthcare Provider Details

I. General information

NPI: 1306627096
Provider Name (Legal Business Name): KAITLAN SIERRA GAULDING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 01/14/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BULL ST STE 200
SAVANNAH GA
31401-3378
US

IV. Provider business mailing address

800 CHESTNUT ST # 57
CHATTANOOGA TN
37402-2510
US

V. Phone/Fax

Practice location:
  • Phone: 912-600-1110
  • Fax:
Mailing address:
  • Phone: 912-600-1110
  • Fax: 888-510-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-78324
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-241445
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: