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General NPI Number Information
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NPI Number | 1407207814
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Entity Type | Organization
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Legal Business Name | WAYNESBORO CLINIC, LLC
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 206 CLIFTON TPKE
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City | WAYNESBORO
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State | TN
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Zip | 38485-2301
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Country | US
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Telephone | 931-722-3677
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Fax | 931-722-4677
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Provider Business Mailing Address
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Address Line | PO BOX 778
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City | WAYNESBORO
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State | TN
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Zip | 38485-0778
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER/PHYSICIAN
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Name | DR. DONALD HOWARD POLK
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Credential | DO
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Telephone | 931-722-3677
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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 | DO127
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License Number State | TN
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