Healthcare Provider Details

I. General information

NPI: 1285882662
Provider Name (Legal Business Name): WAYNE GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 MATTHEW DR STE A
WAYNESBORO MS
39367-2566
US

IV. Provider business mailing address

951 MATTHEW DR STE A
WAYNESBORO MS
39367-2566
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-2401
  • Fax: 601-735-5205
Mailing address:
  • Phone: 601-735-2401
  • Fax: 601-735-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHY WADDELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 601-735-5151