Healthcare Provider Details

I. General information

NPI: 1780878389
Provider Name (Legal Business Name): WAYNESBORO CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 CLIFTON TPKE
WAYNESBORO TN
38485-2301
US

IV. Provider business mailing address

PO BOX 778 206 CLIFTON TURNPIKE
WAYNESBORO TN
38485-0778
US

V. Phone/Fax

Practice location:
  • Phone: 931-722-3677
  • Fax: 931-722-9052
Mailing address:
  • Phone: 931-722-3677
  • Fax: 931-722-9052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD HOWARD POLK
Title or Position: OWNER/PHYSICAN
Credential: D.O.
Phone: 931-722-3677