Provider Demographics
NPI:1497808463
Name:PAYNE, VIRGINIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:J
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 1:1675 LAKELAND DR STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4843
Mailing Address - Country:US
Mailing Address - Phone:601-981-4313
Mailing Address - Fax:
Practice Address - Street 1:1675 LAKELAND DR STE 200
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4843
Practice Address - Country:US
Practice Address - Phone:601-981-4313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS114042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS260000360Medicare ID - Type Unspecified