Provider Demographics
NPI:1447967468
Name:PAYNE, MAURICE
Entity type:Individual
Prefix:
First Name:MAURICE
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 1:8615 ELLIS RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-2837
Mailing Address - Country:US
Mailing Address - Phone:901-497-6375
Mailing Address - Fax:901-416-2692
Practice Address - Street 1:8615 ELLIS RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-2837
Practice Address - Country:US
Practice Address - Phone:901-497-6375
Practice Address - Fax:901-416-2692
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty