Healthcare Provider Details

I. General information

NPI: 1740349240
Provider Name (Legal Business Name): JOHN FREDERICK PAYNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CALEDON COURT, SUITE C PIEDMONT REPRODUCTIVE ENDOCRINOLOGY GROUP (PREG)
GREENVILLE SC
29615-3170
US

IV. Provider business mailing address

17 CALEDON COURT, SUITE C PIEDMONT REPRODUCTIVE ENDOCRINOLOGY GROUP (PREG)
GREENVILLE SC
29615-3170
US

V. Phone/Fax

Practice location:
  • Phone: 864-232-7734
  • Fax: 864-232-7099
Mailing address:
  • Phone: 864-232-7734
  • Fax: 864-232-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number94-00609 CER#56616
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number29794
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: