Provider Demographics
NPI:1447954847
Name:SMALL, JAYLA BREANNA
Entity type:Individual
Prefix:
First Name:JAYLA
Middle Name:BREANNA
Last Name:SMALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 DRAKE WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-2117
Mailing Address - Country:US
Mailing Address - Phone:770-282-0937
Mailing Address - Fax:
Practice Address - Street 1:285 COUNTRY CLUB DR STE 300
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7355
Practice Address - Country:US
Practice Address - Phone:470-944-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician