1851186126 NPI number — PROF. MAKAILA JADE PAYNE RBT PENDING

Table of content: PROF. MAKAILA JADE PAYNE RBT PENDING (NPI 1851186126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851186126 NPI number — PROF. MAKAILA JADE PAYNE RBT PENDING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAYNE
Provider First Name:
MAKAILA
Provider Middle Name:
JADE
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
RBT PENDING
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851186126
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1435 ROSS CLARK CIR STE 1&2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36301-4744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-446-4529
Provider Business Mailing Address Fax Number:
334-446-4622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1435 ROSS CLARK CIR STE 1&2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36301-4744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-446-4529
Provider Business Practice Location Address Fax Number:
334-446-4622
Provider Enumeration Date:
04/09/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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