Basic Information
| Provider Information | |||||||||
| NPI: | 1184062275 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAYNE | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | NORBERTO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, MSPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 HURT PLZ SE STE 630 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303032915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047565737 | ||||||||
| FaxNumber: | 4047561357 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 JESSE HILL JR DR SE FL 2 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303033032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047859800 | ||||||||
| FaxNumber: | 4047859745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2013 | ||||||||
| LastUpdateDate: | 02/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | 83742 | GA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | 2080P0207X | 35200 | AL | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
No ID Information.