Provider Demographics
NPI:1245233030
Name:PAYNE, AMY RUTH (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:RUTH
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:PO BOX 1921
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-1900
Mailing Address - Country:US
Mailing Address - Phone:828-565-0560
Mailing Address - Fax:828-565-0562
Practice Address - Street 1:107 HAYWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721
Practice Address - Country:US
Practice Address - Phone:828-565-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-01671207N00000X
CT044715207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1447152Medicaid
I06723Medicare UPIN
CT070000524Medicare PIN