Provider Demographics
NPI:1548307655
Name:PAYNE, SAMUEL E (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:E
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 W HOSPITAL RD RM 13A-10
Mailing Address - Street 2:EISENHOWER ARMY MEDICAL CENTER
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:706-787-8649
Mailing Address - Fax:706-787-8652
Practice Address - Street 1:300 W HOSPITAL RD
Practice Address - Street 2:EISENHOWER ARMY MEDICAL CENTER
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-8649
Practice Address - Fax:706-787-8652
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2013-10-28
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Provider Licenses
StateLicense IDTaxonomies
GA643162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN