Provider Demographics
NPI:1154313500
Name:PAYNE,JR, DOLFORD FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOLFORD
Middle Name:FRANKLIN
Last Name:PAYNE,JR
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 1:350 WENTWORTH TRL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1542
Mailing Address - Country:US
Mailing Address - Phone:770-569-7471
Mailing Address - Fax:
Practice Address - Street 1:1305 HEMBREE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3816
Practice Address - Country:US
Practice Address - Phone:770-772-9607
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021570208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00530879AMedicaid
GAD40842Medicare UPIN