Provider Demographics
NPI:1205281011
Name:PAYNE, LORI PUTNAM (NP-C/APRN)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:PUTNAM
Last Name:PAYNE
Suffix:
Gender:F
Credentials:NP-C/APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 HIGHWAY 72 E
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-5254
Mailing Address - Country:US
Mailing Address - Phone:864-227-2822
Mailing Address - Fax:864-227-3410
Practice Address - Street 1:2526 HIGHWAY 72 E
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-5254
Practice Address - Country:US
Practice Address - Phone:864-227-2822
Practice Address - Fax:864-227-3410
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20152207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty