Doctor Name: | MR. JAMES R PAYNE |
NPI Number: | 1114912524 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA C |
License Number: | 004295 |
Business Practice Address: | 110 R T Stanley Sr Place Lyons, GA - 30436 |
Business Phone Number: | 9125269355 |
Business Fax Number: | 9125268622 |
Mailing Address: | 110 R T Stanley Sr Place, LYONS |
State: | GA |
Postal Code: | 304365623 |
Phone Number: | 9125269355 |
Fax Number: | 9125268622 |
NPI Enumeration Date: | 09/13/2005 |
NPI Last Update Date: | 01/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 004295 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |