Healthcare Provider Details

I. General information

NPI: 1568826253
Provider Name (Legal Business Name): MICHELLE PAYNE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2959 SHARPSBURG MCCULLUM RD
NEWNAN GA
30265-2297
US

IV. Provider business mailing address

2727 PACES FERRY RD SE STE 1-1100
ATLANTA GA
30339-6151
US

V. Phone/Fax

Practice location:
  • Phone: 770-502-2020
  • Fax:
Mailing address:
  • Phone: 470-271-3418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number082823
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: