=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558963496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WAYNE GENERAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2020
-----------------------------------------------------
Last Update Date | 11/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1325 AZALEA DR
-----------------------------------------------------
City | WAYNESBORO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39367-2258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-671-2825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 951 MATTHEW DR STE A
-----------------------------------------------------
City | WAYNESBORO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39367-2566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-735-2401
-----------------------------------------------------
Fax | 601-735-5205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | LINDA W ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-735-7103
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------