Healthcare Provider Details

I. General information

NPI: 1942536867
Provider Name (Legal Business Name): GILLIS L. PAYNE, JR., M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7006 FULTON COURT
MONTGOMERY AL
36117
US

IV. Provider business mailing address

7006 FULTON COURT
MONTGOMERY AL
36117
US

V. Phone/Fax

Practice location:
  • Phone: 334-244-7209
  • Fax: 334-244-6604
Mailing address:
  • Phone: 334-244-7209
  • Fax: 334-244-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GILLIS L. PAYNE JR.
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 334-244-7209