Individual
GILLIS L PAYNE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7006 FULTON CT, MONTGOMERY, AL 36117-8022
(334) 244-7209
(334) 244-6604
Mailing address
10036 WOODLEY RD, RAMER, AL 36069-6531
(334) 281-7578
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
5281
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000004903
—
AL
01
—
51004903
BCBS PROVIDER NUMBER
AL
Enumeration date
10/13/2005
Last updated
02/14/2011
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