Provider Demographics
NPI:1366436610
Name:PAYNE, JOHN HAMNER III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HAMNER
Last Name:PAYNE
Suffix:III
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 1:2055 NORMANDIE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2732
Mailing Address - Country:US
Mailing Address - Phone:334-288-4624
Mailing Address - Fax:334-280-3628
Practice Address - Street 1:2055 NORMANDIE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2732
Practice Address - Country:US
Practice Address - Phone:334-288-4624
Practice Address - Fax:334-280-3628
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000038742085R0202X
FLME906222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL108112Medicaid
AL108568Medicaid
AL108568Medicaid
051515755Medicare PIN
000058866Medicare PIN
000004904Medicare PIN
000058867Medicare PIN
051504364Medicare PIN
000086909Medicare PIN