Healthcare Provider Details

I. General information

NPI: 1063878676
Provider Name (Legal Business Name): WAYNE GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 MATTHEW DR STE 8
WAYNESBORO MS
39367-2534
US

IV. Provider business mailing address

PO BOX 1249 940 MATTHEW DRIVE, SUITE 8
WAYNESBORO MS
39367-1249
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-7101
  • Fax: 601-735-7181
Mailing address:
  • Phone: 601-735-7101
  • Fax: 601-735-7181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHY WADDELL
Title or Position: CEO
Credential:
Phone: 601-735-7100