Provider Demographics
NPI:1366504474
Name:PAYNE, LARRY JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JEFFREY
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1485 JESSE JEWELL PARKWAY NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:770-534-1711
Mailing Address - Fax:770-532-2422
Practice Address - Street 1:1485 JESSE JEWELL PARKWAY NE
Practice Address - Street 2:SUITE 100
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-534-1711
Practice Address - Fax:770-532-2422
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2014-03-04
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Provider Licenses
StateLicense IDTaxonomies
GA034217207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00456222AMedicaid
GAE88552Medicare UPIN
GA18BDCDFMedicare PIN