Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0207X | Pediatric Hematology-Oncologist | 35200 | AL |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 83742 | GA |
NPI | 1184062275 |
---|---|
Provider Name | Dr. Jason Norberto Payne |
First Address | Atlanta, GA 30303-2915 |
Second Address | Atlanta, GA 30303-3032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2013 |
Last Update Date | 17/02/2021 |