Healthcare Provider Details

I. General information

NPI: 1932022068
Provider Name (Legal Business Name): PAYTON CHARLES HART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 OLD MILTON PKWY STE C390
ALPHARETTA GA
30005-3714
US

IV. Provider business mailing address

3400C OLD MILTON PKWY STE 390
ALPHARETTA GA
30005-4438
US

V. Phone/Fax

Practice location:
  • Phone: 770-881-8100
  • Fax: 770-881-8121
Mailing address:
  • Phone: 770-881-8100
  • Fax: 770-881-8121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA005552
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: