Provider Demographics
NPI:1306920327
Name:PAYNE, JULIE CARALEE (RD, LD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:CARALEE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 ALCOVA DR
Mailing Address - Street 2:
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-4329
Mailing Address - Country:US
Mailing Address - Phone:770-464-4493
Mailing Address - Fax:770-484-0155
Practice Address - Street 1:2277 STONE MOUNTAIN LITHONIA RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-5252
Practice Address - Country:US
Practice Address - Phone:770-484-2600
Practice Address - Fax:770-484-3830
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD603840133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ06387Medicare UPIN
GA71BBMLMedicare ID - Type Unspecified