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General NPI Number Information
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NPI Number | 1427068386
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Entity Type | Individual
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Provider Name | LEE JUSTIN PAYNE DMD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 5391 HIGHWAY 53 SUITE 101
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City | BRASELTON
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State | GA
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Zip | 30517-3135
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Country | US
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Telephone | 706-546-1557
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Fax | 678-546-1842
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Provider Business Mailing Address
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Address Line | 3360 HADDON HALL DR
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City | BUFORD
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State | GA
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Zip | 30519-4056
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Country | US
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Telephone | 678-546-1842
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Fax | 678-546-1842
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN013350
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License Number State | GA
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