Provider Demographics
NPI:1265043368
Name:BROWN, PAYTON ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:PAYTON
Middle Name:ELIZABETH
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAYTON
Other - Middle Name:ELIZABETH
Other - Last Name:BURRISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30673-5619
Mailing Address - Country:US
Mailing Address - Phone:706-678-6944
Mailing Address - Fax:
Practice Address - Street 1:212 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:GA
Practice Address - Zip Code:30673-5619
Practice Address - Country:US
Practice Address - Phone:706-678-6944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10043363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10043OtherPHYSICIAN ASSISTANT LICENSE
GA003242617AMedicaid
GAMB6104397OtherDEA