Healthcare Provider Details

I. General information

NPI: 1649240193
Provider Name (Legal Business Name): WAYNE D HORNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E MAIN ST
FLOYD VA
24091-4183
US

IV. Provider business mailing address

221 HERITAGE WAY
WYTHEVILLE VA
24382-5717
US

V. Phone/Fax

Practice location:
  • Phone: 540-745-2031
  • Fax:
Mailing address:
  • Phone: 276-228-6970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101-030867
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: