MEDICARE: MS. MARCENIA LARENA PAYNE LMSW

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	101Y00000X	Counselor	MSW004203	GA

General Provider Information

NPI Number	:	1861699209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCENIA LARENA PAYNE LMSW

Provider Business Mailing Address
First Line	:	399 LANGSHIRE DR
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-8051
Country	:	US
Telephone Number	:	678-289-0713
Fax Number	:	879-289-9582

Provider Business Practice Location Address
First Line	:	2380 DELOWE DR
Second Line	:	SUITE 1
City	:	EAST POINT
State	:	GA
Zip	:	30344-2154
Country	:	US
Telephone Number	:	404-761-7915
Fax Number	:	404-761-2784

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	07/08/2007

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