Larry Jason Payne, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN012442 Issued in GA

Practice address

4965 Friendship Rd
Suite 105
Buford, GA 30518-1700

Phone

(770) 614-7122

Fax

(770) 614-7211

NPI assigned

Apr 3, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689795148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4965 FRIENDSHIP RD",
            "address_2": "SUITE 105",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305181700",
            "telephone_number": "770-614-7122",
            "fax_number": "770-614-7211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4965 FRIENDSHIP RD",
            "address_2": "SUITE 105",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305181700",
            "telephone_number": "770-614-7122",
            "fax_number": "770-614-7211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAYNE",
        "first_name": "LARRY",
        "middle_name": "JASON",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN012442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00940783B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Paul
• Roger Wayne Paul, DC
• Paula Elliott DC PC
• Melissa Romulus Pauline, AGPCNP-C
• Veronica Marie Pausa, MS, APC
• Mathew Peace, PT, DPT
• Peach State Care Partners
• Peach State Pediatric Therapy
• Peachpoint Clinic
• Pearls Dentistry LLC

• General Practice Dentistry in Buford, GA
• Providers in Buford, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.