Provider Demographics
NPI:1184369183
Name:PAYTON, LORI (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:PAYTON
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 CLIPPER BAY DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4990
Mailing Address - Country:US
Mailing Address - Phone:504-432-5706
Mailing Address - Fax:
Practice Address - Street 1:5525 CLIPPER BAY DR
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-4990
Practice Address - Country:US
Practice Address - Phone:504-432-5706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAL-144273163WL0100X
GARN219962163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse