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General NPI Number Information
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NPI Number | 1912273228
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Entity Type | Individual
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Provider Name | THOMAS J PAYNE PHD
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Gender | Male
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 350 W WOODROW WILSON AVE JACKSON MEDICAL MALL, STE ME-102
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City | JACKSON
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State | MS
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Zip | 39213-7681
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Country | US
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Telephone | 601-615-1180
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Fax | 601-815-5986
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Provider Business Mailing Address
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Address Line | 350 W WOODROW WILSON AVE JACKSON MEDICAL MALL, STE ME-102
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City | JACKSON
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State | MS
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Zip | 39213-7681
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Country | US
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Telephone | 601-615-1180
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Fax | 601-815-5986
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 28-386
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License Number State | MS
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