Provider Demographics
NPI:1205854452
Name:PAYNE, JOSEPH MINTER
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MINTER
Last Name:PAYNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-662-7720
Mailing Address - Fax:910-815-0840
Practice Address - Street 1:2221 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7542
Practice Address - Country:US
Practice Address - Phone:910-662-7720
Practice Address - Fax:910-815-0840
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29494208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC020030293OtherRAILROAD MEDICARE
NC66291OtherBCBS NC
NC8966291Medicaid
NC020030293OtherRAILROAD MEDICARE
NC8966291Medicaid