Provider Demographics
NPI:1033891676
Name:RUSSELL, PAYTON (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:PAYTON
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 OAKHURST DR STE A
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3712
Mailing Address - Country:US
Mailing Address - Phone:706-831-1128
Mailing Address - Fax:770-230-0157
Practice Address - Street 1:805 OAKHURST DR STE A
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3712
Practice Address - Country:US
Practice Address - Phone:706-831-1128
Practice Address - Fax:770-230-0157
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003883235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist