Provider Demographics
NPI:1407233612
Name:WAYNE GENERAL HOSPITAL
Entity Type:Organization
Organization Name:WAYNE GENERAL HOSPITAL
Other - Org Name:WAYNE GENERAL SURGERY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-735-7100
Mailing Address - Street 1:PO BOX 1249
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-1249
Mailing Address - Country:US
Mailing Address - Phone:601-735-7285
Mailing Address - Fax:
Practice Address - Street 1:940 MATTHEW DR
Practice Address - Street 2:SUITE 5
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2522
Practice Address - Country:US
Practice Address - Phone:601-735-7285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAYNE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-27
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center