Provider Demographics
NPI:1073792388
Name:PAYNE, JONATHAN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PAUL
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 ROSS CLARK CIR STE 600
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3042
Mailing Address - Country:US
Mailing Address - Phone:334-793-3900
Mailing Address - Fax:334-793-5227
Practice Address - Street 1:1118 ROSS CLARK CIR STE 600
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3042
Practice Address - Country:US
Practice Address - Phone:334-793-3900
Practice Address - Fax:334-793-5227
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063938207V00000X
AL28408207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA454780609AMedicaid
GA454780609AMedicaid