Provider Demographics
NPI:1326653304
Name:PAINE, SAFAYIA (LMT)
Entity Type:Individual
Prefix:MS
First Name:SAFAYIA
Middle Name:
Last Name:PAINE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-2208
Mailing Address - Country:US
Mailing Address - Phone:706-691-7824
Mailing Address - Fax:
Practice Address - Street 1:1420 CAMBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-2208
Practice Address - Country:US
Practice Address - Phone:706-691-7824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT005725225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist