Provider Demographics
NPI:1225021306
Name:PAYNE, MERCEDES V (MD)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:V
Last Name:PAYNE
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 1:8850 RHEA COUNTY HWY STE 12
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-7932
Mailing Address - Country:US
Mailing Address - Phone:423-775-1160
Mailing Address - Fax:423-775-1047
Practice Address - Street 1:22576 RHEA COUNTY HWY
Practice Address - Street 2:STE. 1, 2 & 3
Practice Address - City:SPRING CITY
Practice Address - State:TN
Practice Address - Zip Code:37381-5393
Practice Address - Country:US
Practice Address - Phone:423-365-4486
Practice Address - Fax:423-822-5464
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801436207Q00000X
VA0101233065207Q00000X
TN48882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530219Medicaid
VA010150761Medicaid
TNQ030008Medicaid
TNQ030008Medicaid
VA00W510P02Medicare PIN
VAH64955Medicare UPIN
TN1530219Medicaid