Provider Demographics
NPI:1033251541
Name:PAYNE-PAMPHILE, ROSLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSLYN
Middle Name:
Last Name:PAYNE-PAMPHILE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5495 OLD NATIONAL HWY STE B2
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3254
Mailing Address - Country:US
Mailing Address - Phone:404-559-8847
Mailing Address - Fax:404-559-8998
Practice Address - Street 1:5495 OLD NATIONAL HWY STE B2
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3254
Practice Address - Country:US
Practice Address - Phone:404-559-8847
Practice Address - Fax:404-559-8998
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA35972208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics