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General NPI Number Information
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NPI Number | 1467887877
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Entity Type | Individual
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Provider Name | TREVOR SEAN PAYNE D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 07/03/2019
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Provider Practice Location Address
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Address Line | 1416 WAINBROOK DR
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City | AUGUSTA
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State | GA
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Zip | 30909-6289
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Country | US
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Telephone | 706-312-3668
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Fax | 706-312-3680
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Provider Business Mailing Address
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Address Line | 1416 WAINBROOK DR
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City | AUGUSTA
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State | GA
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Zip | 30909-6289
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Country | US
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Telephone | 706-312-3668
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Fax | 706-312-3680
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PR354
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD001309
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License Number State | GA
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