Provider Demographics
NPI:1578501441
Name:PAYNE, KARROLL L (MD)
Entity Type:Individual
Prefix:
First Name:KARROLL
Middle Name:L
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARROLL
Other - Middle Name:PAYNE
Other - Last Name:MCGREGOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0474
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:420 AVENUE F
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3634
Practice Address - Country:US
Practice Address - Phone:985-730-7001
Practice Address - Fax:985-730-7006
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-03778207V00000X
LA207860207V00000X
LAMD207860207V00000X
GA55134207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7474677OtherAETNA/USHC
GA390341OtherBLUE CROSS BLUE SHIELD
GA0701646OtherUNITED HEALTHCARE
GA341881697AMedicaid
GAP00282637OtherRAILROAD MEDICARE
GA3771799OtherAETNA/USHC
GA341881697FMedicaid
GA341881697FMedicaid
GA16BBCPKMedicare ID - Type Unspecified