Provider Demographics
NPI:1730102740
Name:PAYNE, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 LAKELAND DR
Mailing Address - Street 2:STE. 850
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4608
Mailing Address - Country:US
Mailing Address - Phone:601-981-8543
Mailing Address - Fax:601-364-5498
Practice Address - Street 1:971 LAKELAND DR
Practice Address - Street 2:STE. 850
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4608
Practice Address - Country:US
Practice Address - Phone:601-981-8543
Practice Address - Fax:601-364-5498
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17690207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1135585Medicaid
MSRR 060069250OtherRAILROAD
MS00125908Medicaid
MSP00628046OtherRAILROAD
MSP00628046OtherRAILROAD
LA1135585Medicaid
MS00125908Medicaid