Provider Demographics
NPI:1811270945
Name:CALHOUN PAYTON, ANDREA D
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:D
Last Name:CALHOUN PAYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:D
Other - Last Name:CALHOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6173 PEMBROKE DR
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-1245
Mailing Address - Country:US
Mailing Address - Phone:404-384-7835
Mailing Address - Fax:678-289-8063
Practice Address - Street 1:6173 PEMBROKE DR
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-1245
Practice Address - Country:US
Practice Address - Phone:404-384-7835
Practice Address - Fax:678-289-8063
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
GACN0000127439372600000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion