MEDICARE: KYLE SMITH

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1932870557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE SMITH

Provider Business Mailing Address
First Line	:	69 LINDSEY LN STE B
Second Line	:
City	:	SAINT MARYS
State	:	GA
Zip	:	31558-1702
Country	:	US
Telephone Number	:	912-266-8686
Fax Number	:

Provider Business Practice Location Address
First Line	:	11720 AMBERPARK DR STE 160
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-2271
Country	:	US
Telephone Number	:	770-870-1812
Fax Number	:

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

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	09/23/2021

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Directions to “ KYLE SMITH ” Practice Location

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