Provider Demographics
NPI:1134790470
Name:PAYTON, ALISHA MACKENZIE
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:MACKENZIE
Last Name:PAYTON
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 1:658 WESTERN PARK DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38109-5175
Mailing Address - Country:US
Mailing Address - Phone:901-633-3206
Mailing Address - Fax:
Practice Address - Street 1:658 WESTERN PARK DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-5175
Practice Address - Country:US
Practice Address - Phone:901-633-3206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker