Provider Demographics
NPI:1558343921
Name:PAYNE, RICHARD JOHN (MED)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOHN
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 N JACKSON ST
Mailing Address - Street 2:RENAISSANCE CENTRE
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2308
Mailing Address - Country:US
Mailing Address - Phone:229-889-7200
Mailing Address - Fax:229-889-7393
Practice Address - Street 1:506 N JACKSON ST
Practice Address - Street 2:THE RENAISSANCE CENTRE
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2308
Practice Address - Country:US
Practice Address - Phone:229-889-7200
Practice Address - Fax:229-889-7393
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional