Provider Demographics
NPI:1891312765
Name:PAYNE, FABRIENNE (MPH)
Entity Type:Individual
Prefix:
First Name:FABRIENNE
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 COLONY PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8746
Mailing Address - Country:US
Mailing Address - Phone:803-920-5793
Mailing Address - Fax:
Practice Address - Street 1:1501 SUMTER ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2829
Practice Address - Country:US
Practice Address - Phone:803-920-5793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174H00000XOther Service ProvidersHealth Educator