Healthcare Provider Details

I. General information

NPI: 1447412374
Provider Name (Legal Business Name): WAYNE FREDERICK HOMAN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 OWEN DR
FAYETTEVILLE NC
28304-3419
US

IV. Provider business mailing address

590 MANNING DRIVE CAMPUS BOX 7595
CHAPEL HILL NC
27599-7595
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-3184
  • Fax:
Mailing address:
  • Phone: 919-966-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0101246577
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101246577
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number2019-00952
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: