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NPI Code Detail

MEDICARE: PEYTON MARIE HENDERSON

MEDICARE: PEYTON MARIE HENDERSON
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
1106S00000XBehavior TechnicianBACB709777AL

General Provider Information

NPI Number : 1932840956
Entity Type Code : Individual
Provider Name (Legal Business Name) : PEYTON MARIE HENDERSON
Provider Business Mailing Address
First Line : 166 GRAY ST
Second Line :
City : TRION
State : GA
Zip : 30753-1402
Country : US
Telephone Number : 706-936-1356
Fax Number :
Provider Business Practice Location Address
First Line : 805 MADISON ST SE STE 2E
Second Line :
City : HUNTSVILLE
State : AL
Zip : 35801-4424
Country : US
Telephone Number : 256-755-4278
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2022
Last Update Date : 04/05/2022

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Directions to “ PEYTON MARIE HENDERSON ” Practice Location

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