Healthcare Provider Details

I. General information

NPI: 1144669763
Provider Name (Legal Business Name): CYNTHIA PAYNE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE SUITE 1275
ATLANTA GA
30308-2208
US

IV. Provider business mailing address

2317 LOCHINVER LN SW SUITE 1275
CONYERS GA
30094-6853
US

V. Phone/Fax

Practice location:
  • Phone: 404-872-3121
  • Fax:
Mailing address:
  • Phone: 404-429-3693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN101017
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: