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General NPI Number Information
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NPI Number | 1114962487
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Entity Type | Organization
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Legal Business Name | WAYNE FAMILY PRACTICE ASSOCIATES, P.C.
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 118 AZALEA RD STE 1
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City | BAXLEY
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State | GA
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Zip | 31513-9197
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Country | US
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Telephone | 912-294-0380
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Fax | 912-427-0591
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Provider Business Mailing Address
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Address Line | 118 AZALEA RD STE 1
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City | BAXLEY
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State | GA
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Zip | 31513-9197
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Country | US
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Telephone | 912-294-0380
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Fax | 912-427-0591
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | KEVIN O. KEOWN
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Credential |
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Telephone | 912-294-0380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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