Provider Demographics
NPI:1174652275
Name:PAYNE-JOHNSON, ANN ILENE (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:ILENE
Last Name:PAYNE-JOHNSON
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 1:3929-1 AIRPORT BLVD
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609
Mailing Address - Country:US
Mailing Address - Phone:251-434-3475
Mailing Address - Fax:251-434-3985
Practice Address - Street 1:1601 CENTER ST STE 2N
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1541
Practice Address - Country:US
Practice Address - Phone:251-434-3475
Practice Address - Fax:251-434-3985
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113587207Q00000X, 207QB0002X
ALMD.42647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN30011791Medicare PIN