Healthcare Provider Details

I. General information

NPI: 1699982108
Provider Name (Legal Business Name): WAYNE ENT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PEACHTREE ST
JESUP GA
31545-0244
US

IV. Provider business mailing address

320 PEACHTREE ST
JESUP GA
31545-0244
US

V. Phone/Fax

Practice location:
  • Phone: 912-427-7790
  • Fax: 912-427-7707
Mailing address:
  • Phone: 912-427-7790
  • Fax: 912-427-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILIAM DONALD DAVIDSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 912-427-7790