Provider Demographics
NPI:1861602161
Name:PAYNE, DONNIE HERBERT (PHARMACIST)
Entity type:Individual
Prefix:
First Name:DONNIE
Middle Name:HERBERT
Last Name:PAYNE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546-1682
Mailing Address - Country:US
Mailing Address - Phone:706-896-2337
Mailing Address - Fax:706-896-5742
Practice Address - Street 1:230 HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-5526
Practice Address - Country:US
Practice Address - Phone:828-389-2804
Practice Address - Fax:828-389-2832
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11717183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist