Provider Demographics
NPI:1457528986
Name:PAYNE, NICOLE YLONNE (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:YLONNE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:460 MALL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4801
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-3369
Practice Address - Street 1:100 DOCTORS DR
Practice Address - Street 2:SUITE I
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2210
Practice Address - Country:US
Practice Address - Phone:912-383-6575
Practice Address - Fax:912-383-6476
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA068269208100000X
OH35.091613208100000X
WAMD60463507208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00703245OtherRRMCR
WA326916OtherSTATE L&I
TN1508994Medicaid
TN1508994Medicaid
TNP00703245OtherRRMCR