Provider Demographics
NPI:1912583675
Name:PAYNE, PRESLEY HAYNES III
Entity Type:Individual
Prefix:MR
First Name:PRESLEY
Middle Name:HAYNES
Last Name:PAYNE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 DAWN VIEW TER
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4697
Mailing Address - Country:US
Mailing Address - Phone:843-992-5102
Mailing Address - Fax:
Practice Address - Street 1:849 SARNO RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5027
Practice Address - Country:US
Practice Address - Phone:843-992-5102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health