Healthcare Provider Details

I. General information

NPI: 1598787160
Provider Name (Legal Business Name): WAYNE GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 MATTHEW DR STE C
WAYNESBORO MS
39367-2566
US

IV. Provider business mailing address

951 MATTHEW DR STE C
WAYNESBORO MS
39367-2566
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-5500
  • Fax: 601-735-5533
Mailing address:
  • Phone: 601-735-5500
  • Fax: 601-735-5533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number11288
License Number StateMS

VIII. Authorized Official

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