Provider Demographics
NPI:1639936784
Name:PAYNE, KIMBERLY KRISTEN
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KRISTEN
Last Name:PAYNE
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 1:4443 GROVE DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-6397
Mailing Address - Country:US
Mailing Address - Phone:770-617-4251
Mailing Address - Fax:
Practice Address - Street 1:4443 GROVE DR NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-6397
Practice Address - Country:US
Practice Address - Phone:770-617-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician