MEDICARE: TENEKIA PAYNE

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
1	1041C0700X	Clinical Social Worker	149029404	IL

General Provider Information

NPI Number	:	1467016998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENEKIA PAYNE

Provider Business Mailing Address
First Line	:	3040 HOLCOMB BRIDGE RD
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30071-1377
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 HEATHERWILDE BLVD APT 431
Second Line	:
City	:	PFLUGERVILLE
State	:	TX
Zip	:	78660-4565
Country	:	US
Telephone Number	:	601-466-4510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2019
Last Update Date	:	06/08/2026

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Directions to “ TENEKIA PAYNE ” Practice Location

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