Provider Demographics
NPI:1124134762
Name:CRAYCRAFT PAYNE, AMY MARIE (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:CRAYCRAFT PAYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:CRAYCRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3686 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6520
Mailing Address - Country:US
Mailing Address - Phone:706-922-6300
Mailing Address - Fax:706-922-6303
Practice Address - Street 1:1201 WEST AVE
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3350
Practice Address - Country:US
Practice Address - Phone:803-279-1030
Practice Address - Fax:803-278-1344
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58048207Q00000X
SC30432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA102I081896OtherMEDICARE
GA058408OtherSTATE OF GEORGIA LICENSE
SC30432OtherSC MEDICAL LICENSE
SCG58408Medicaid
SC20-30432OtherSC CONTROLLED SUBSTANCES
SCSC5305D839OtherMEDICARE
SC20-30432OtherSC CONTROLLED SUBSTANCES
SCSC5305D839OtherMEDICARE