Healthcare Provider Details

I. General information

NPI: 1154313500
Provider Name (Legal Business Name): DOLFORD FRANKLIN PAYNE,JR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 HEMBREE RD SUITE 204
ROSWELL GA
30076-3816
US

IV. Provider business mailing address

350 WENTWORTH TRL
ALPHARETTA GA
30022-1542
US

V. Phone/Fax

Practice location:
  • Phone: 770-772-9607
  • Fax:
Mailing address:
  • Phone: 770-569-7471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number021570
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: