Healthcare Provider Details

I. General information

NPI: 1407233612
Provider Name (Legal Business Name): WAYNE GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 MATTHEW DR SUITE 5
WAYNESBORO MS
39367-2522
US

IV. Provider business mailing address

PO BOX 1249
WAYNESBORO MS
39367-1249
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-7285
  • Fax:
Mailing address:
  • Phone: 601-735-7285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID ANDREW PORTER
Title or Position: CEO
Credential:
Phone: 601-735-5151