Healthcare Provider Details

I. General information

NPI: 1740957109
Provider Name (Legal Business Name): KATHERINE ANDREA THOMAS PAYTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 GLENWOOD AVE SE UNIT 1505
ATLANTA GA
30316-1890
US

IV. Provider business mailing address

951 GLENWOOD AVE SE UNIT 1505
ATLANTA GA
30316-1890
US

V. Phone/Fax

Practice location:
  • Phone: 404-285-4626
  • Fax:
Mailing address:
  • Phone: 404-285-4626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN089955
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: