Provider Demographics
NPI:1467837161
Name:THE PAYNE GROUP, LLC
Entity Type:Organization
Organization Name:THE PAYNE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DOLFORD
Authorized Official - Middle Name:F
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:770-772-9607
Mailing Address - Street 1:17 RIVER SOUND CIR
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-0735
Mailing Address - Country:US
Mailing Address - Phone:770-772-9607
Mailing Address - Fax:770-772-9812
Practice Address - Street 1:17 RIVER SOUND CIR
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-0735
Practice Address - Country:US
Practice Address - Phone:770-772-9607
Practice Address - Fax:770-772-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA137363722AMedicare UPIN