Provider Demographics
NPI:1295804284
Name:PAYNE, GERALDINE STEWART (MD)
Entity type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:STEWART
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GERALDINE
Other - Middle Name:PAYNE
Other - Last Name:SEASTRUNK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8574
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-8574
Mailing Address - Country:US
Mailing Address - Phone:985-674-1399
Mailing Address - Fax:985-626-3253
Practice Address - Street 1:111 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-4646
Practice Address - Country:US
Practice Address - Phone:985-674-1399
Practice Address - Fax:985-626-3253
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA97942084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
57504Medicare ID - Type Unspecified
5L067Medicare UPIN