MEDICARE: DR. NETTLETON S PAYNE II MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	016406	GA

General Provider Information

NPI Number	:	1124268313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NETTLETON S PAYNE II MD

Provider Business Mailing Address
First Line	:	3586 TUXEDO PARK NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-1041
Country	:	US
Telephone Number	:	404-262-1043
Fax Number	:	404-262-1264

Provider Business Practice Location Address
First Line	:	3586 TUXEDO PARK NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-1041
Country	:	US
Telephone Number	:	404-262-1043
Fax Number	:	404-262-1264

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2009
Last Update Date	:	02/27/2009

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