Healthcare Provider Details

I. General information

NPI: 1205707494
Provider Name (Legal Business Name): PAYTON HENRY RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 LANIER PARK DR
GAINESVILLE GA
30501-2059
US

IV. Provider business mailing address

850 COLLEGE STATION RD BLDG 2
ATHENS GA
30605-2718
US

V. Phone/Fax

Practice location:
  • Phone: 943-202-3634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA003048
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: