Healthcare Provider Details

I. General information

NPI: 1457297277
Provider Name (Legal Business Name): KAILYN J'KAI SUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5028 GOLF LINK CT
STONE MOUNTAIN GA
30088-3705
US

IV. Provider business mailing address

5028 GOLF LINK CT
STONE MOUNTAIN GA
30088-3705
US

V. Phone/Fax

Practice location:
  • Phone: 770-291-9716
  • Fax: 770-291-9716
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-269701
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: