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General NPI Number Information
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NPI Number | 1760417570
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Entity Type | Organization
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Legal Business Name | WAYNESBORO FAMILY CLINIC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/31/2016
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Provider Practice Location Address
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Address Line | 1706 WAYNE MEMORIAL DR
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City | GOLDSBORO
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State | NC
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Zip | 27534-2240
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Country | US
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Telephone | 919-734-6676
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Fax | 919-734-9050
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Provider Business Mailing Address
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Address Line | 1706 WAYNE MEMORIAL DR
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City | GOLDSBORO
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State | NC
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Zip | 27534-2240
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Country | US
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Telephone | 919-734-6676
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Fax | 919-734-9050
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | NITA VANNOSKE
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Credential |
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Telephone | 919-734-6676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 34D2077478
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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