Provider Demographics
NPI:1114591799
Name:HAMPTON-PADILLA, ALLYSON MARIE
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:MARIE
Last Name:HAMPTON-PADILLA
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 1:6 FITZWATER RD
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-6017
Mailing Address - Country:US
Mailing Address - Phone:609-351-7134
Mailing Address - Fax:
Practice Address - Street 1:613 TOWNE PARK DR W STE 103
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9098
Practice Address - Country:US
Practice Address - Phone:912-677-4292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT19104790106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician