Provider Demographics
NPI:1649512039
Name:PAYNE, JONATHAN HOWARD (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:HOWARD
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 1:1500 OGELTHORPE AVENUE SUITE 500B
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606
Mailing Address - Country:US
Mailing Address - Phone:706-613-5880
Mailing Address - Fax:706-613-5889
Practice Address - Street 1:1500 OGELTHORPE AVENUE SUITE 500B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-613-5880
Practice Address - Fax:706-613-5889
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-23
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101257508207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty