Provider Demographics
NPI:1861702383
Name:WAYNE GENERAL HOSPITAL
Entity type:Organization
Organization Name:WAYNE GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-735-7100
Mailing Address - Street 1:951 MATTHEW DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-2565
Mailing Address - Country:US
Mailing Address - Phone:601-735-2401
Mailing Address - Fax:601-735-5205
Practice Address - Street 1:951 MATTHEW DR
Practice Address - Street 2:SUITE A
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2565
Practice Address - Country:US
Practice Address - Phone:601-735-2401
Practice Address - Fax:601-735-5205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAYNE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-18
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09011779Medicaid
MS09011779Medicaid