Healthcare Provider Details

I. General information

NPI: 1437169521
Provider Name (Legal Business Name): WAYNE E GRAYSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6941 HIGHWAY 11 STE A
CARRIERE MS
39426-7794
US

IV. Provider business mailing address

415 S 28TH AVE
HATTIESBURG MS
39401-7246
US

V. Phone/Fax

Practice location:
  • Phone: 601-749-3776
  • Fax: 601-749-3748
Mailing address:
  • Phone: 601-749-3776
  • Fax: 601-749-3748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number06726
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: