Provider Demographics
NPI:1003709486
Name:WITT, PAYTON JAMISON
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:JAMISON
Last Name:WITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 OLD PRINCETON RD APT F
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-4800
Mailing Address - Country:US
Mailing Address - Phone:770-616-8582
Mailing Address - Fax:
Practice Address - Street 1:150 OLD PRINCETON RD APT F
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-4800
Practice Address - Country:US
Practice Address - Phone:770-616-8582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program