Healthcare Provider Details

I. General information

NPI: 1811270945
Provider Name (Legal Business Name): ANDREA D CALHOUN PAYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA D CALHOUN

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6173 PEMBROKE DR
REX GA
30273-1245
US

IV. Provider business mailing address

6173 PEMBROKE DR
REX GA
30273-1245
US

V. Phone/Fax

Practice location:
  • Phone: 404-384-7835
  • Fax: 678-289-8063
Mailing address:
  • Phone: 404-384-7835
  • Fax: 678-289-8063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberCN0000127439
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCN0000127439
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: