Provider Demographics
NPI:1427068386
Name:PAYNE, LEE JUSTIN (DMD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:JUSTIN
Last Name:PAYNE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 HADDON HALL DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4056
Mailing Address - Country:US
Mailing Address - Phone:678-546-1842
Mailing Address - Fax:678-546-1842
Practice Address - Street 1:5391 HIGHWAY 53
Practice Address - Street 2:SUITE 101
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-3135
Practice Address - Country:US
Practice Address - Phone:706-546-1557
Practice Address - Fax:678-546-1842
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013350122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist