Healthcare Provider Details

I. General information

NPI: 1376885277
Provider Name (Legal Business Name): WAYNE HEALTH SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 MCLAMB PL
GOLDSBORO NC
27534-1647
US

IV. Provider business mailing address

PO BOX 1717
GOLDSBORO NC
27533-1717
US

V. Phone/Fax

Practice location:
  • Phone: 919-738-4114
  • Fax: 919-587-0775
Mailing address:
  • Phone: 919-734-1141
  • Fax: 919-587-0775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CLYDE LOUIS THOMAS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-587-4081