Healthcare Provider Details

I. General information

NPI: 1093779621
Provider Name (Legal Business Name): WAYNE RADIOLOGISTS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 MEDICAL OFFICE PL
GOLDSBORO NC
27534-9460
US

IV. Provider business mailing address

2700 MEDICAL OFFICE PL
GOLDSBORO NC
27534-9460
US

V. Phone/Fax

Practice location:
  • Phone: 919-736-5300
  • Fax: 919-736-1804
Mailing address:
  • Phone: 919-736-5300
  • Fax: 919-736-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number39524
License Number StateNC

VIII. Authorized Official

Name: MS. JESSICA L BYRD
Title or Position: OFFICE MANAGER
Credential:
Phone: 919-736-5315