Healthcare Provider Details

I. General information

NPI: 1558963496
Provider Name (Legal Business Name): WAYNE GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 AZALEA DR
WAYNESBORO MS
39367-2258
US

IV. Provider business mailing address

951 MATTHEW DR STE A
WAYNESBORO MS
39367-2566
US

V. Phone/Fax

Practice location:
  • Phone: 601-671-2825
  • Fax:
Mailing address:
  • Phone: 601-735-2401
  • Fax: 601-735-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA W ANDERSON
Title or Position: CFO
Credential:
Phone: 601-735-7103