Provider Demographics
NPI:1053765198
Name:PAYNE, ANTHONY
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:PAYNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 S SHERWOOD FRST STE 204
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2250
Mailing Address - Country:US
Mailing Address - Phone:225-276-3824
Mailing Address - Fax:
Practice Address - Street 1:4021 WE HECK CT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-0416
Practice Address - Country:US
Practice Address - Phone:225-302-5804
Practice Address - Fax:225-302-5825
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator