Provider Demographics
NPI:1053661066
Name:WAYNE HEALTH PHYSICIANS
Entity Type:Organization
Organization Name:WAYNE HEALTH PHYSICIANS
Other - Org Name:WAYNE HEALTH PSYCHIATRIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-587-4081
Mailing Address - Street 1:208 COX BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9414
Mailing Address - Country:US
Mailing Address - Phone:919-587-4051
Mailing Address - Fax:919-580-1083
Practice Address - Street 1:208 COX BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9414
Practice Address - Country:US
Practice Address - Phone:919-587-4051
Practice Address - Fax:919-580-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty