Provider Demographics
NPI:1922750900
Name:PAYNE, JOHN DAVID (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:PAYNE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3026 FORESTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-9406
Mailing Address - Country:US
Mailing Address - Phone:336-209-6592
Mailing Address - Fax:
Practice Address - Street 1:3511 W MARKET ST STE 100
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-4444
Practice Address - Country:US
Practice Address - Phone:336-522-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11906363A00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant