Healthcare Provider Details

I. General information

NPI: 1659310357
Provider Name (Legal Business Name): WILLIAM R PAYNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WILLIAM RICHARD PAYNE MD

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 JOE FRANK HARRIS PKWY STE 350
CARTERSVILLE GA
30120
US

IV. Provider business mailing address

PO BOX 200429
CARTERSVILLE GA
30120-9008
US

V. Phone/Fax

Practice location:
  • Phone: 770-386-3011
  • Fax: 770-386-9451
Mailing address:
  • Phone: 770-386-3011
  • Fax: 770-386-9451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number028856
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: