MEDICARE: KAYLA REYNOLDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-25-82693	GA

General Provider Information

NPI Number	:	1891687505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA REYNOLDS

Provider Business Mailing Address
First Line	:	106 PRESERVE PKWY
Second Line	:
City	:	BALL GROUND
State	:	GA
Zip	:	30107-3226
Country	:	US
Telephone Number	:	678-231-4060
Fax Number	:

Provider Business Practice Location Address
First Line	:	6225 ATLANTA HWY
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30004-8797
Country	:	US
Telephone Number	:	770-227-6286
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2025
Last Update Date	:	07/17/2025

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