Healthcare Provider Details

I. General information

NPI: 1003588096
Provider Name (Legal Business Name): KAITLYN EYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 CENTERVILLE HWY
SNELLVILLE GA
30078-4503
US

IV. Provider business mailing address

600 3RD AVE FL 2
NEW YORK NY
10016-1919
US

V. Phone/Fax

Practice location:
  • Phone: 678-841-7736
  • Fax:
Mailing address:
  • Phone: 678-841-7736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-188248
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-26-90015
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: