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General NPI Number Information
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NPI Number | 1730699406
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Entity Type | Organization
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Legal Business Name | JAMES N PAYNE NP-C LLC
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 5090 GAUTIER VANCLEAVE RD
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City | GAUTIER
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State | MS
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Zip | 39553-4803
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Country | US
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Telephone | 228-522-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 106A OFFICE PARK DR
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City | BRANDON
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State | MS
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Zip | 39042-2404
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Country | US
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Telephone | 601-824-9010
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Fax | 601-824-9044
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Authorized Official
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Title or Position | CFO
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Name | SONJA SHARP WATKINS
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Credential |
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Telephone | 601-824-9010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R865473
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License Number State | MS
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