Healthcare Provider Details

I. General information

NPI: 1235341132
Provider Name (Legal Business Name): JOYCE PAYNE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 SCOGGINS DR
DEMOREST GA
30535-5355
US

IV. Provider business mailing address

185 SCOGGINS DR
DEMOREST GA
30535-5355
US

V. Phone/Fax

Practice location:
  • Phone: 706-778-7156
  • Fax:
Mailing address:
  • Phone: 706-778-7156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN165654
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: