Provider Demographics
NPI:1164969192
Name:PAYTON, HENRY (PA)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:PAYTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BURNT HICKORY RD NW
Mailing Address - Street 2:APT 231
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1368
Mailing Address - Country:US
Mailing Address - Phone:972-815-9121
Mailing Address - Fax:
Practice Address - Street 1:1001 BURNT HICKORY RD NW
Practice Address - Street 2:APT 231
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1368
Practice Address - Country:US
Practice Address - Phone:972-185-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-29
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4396363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical