Provider Demographics
NPI:1447016332
Name:PAYNE, MARLEAH (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:MARLEAH
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6298 RIVOLI DR APT 201
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-0029
Mailing Address - Country:US
Mailing Address - Phone:423-762-4289
Mailing Address - Fax:
Practice Address - Street 1:6298 RIVOLI DR APT 201
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-0029
Practice Address - Country:US
Practice Address - Phone:423-762-4289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006244133V00000X
TN4167133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered