Provider Demographics
NPI:1043768369
Name:PAYTON ENTERPRISE, LLC
Entity Type:Organization
Organization Name:PAYTON ENTERPRISE, LLC
Other - Org Name:MATRIX MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANT
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-941-3891
Mailing Address - Street 1:165 EDGE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-9169
Mailing Address - Country:US
Mailing Address - Phone:678-941-3891
Mailing Address - Fax:678-228-1424
Practice Address - Street 1:165 EDGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-9169
Practice Address - Country:US
Practice Address - Phone:678-941-3891
Practice Address - Fax:678-228-1424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies