Provider Demographics
NPI:1477518256
Name:DARVILLE, WAYNE N (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:N
Last Name:DARVILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 PROFESSIONAL CT SE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-7020
Mailing Address - Country:US
Mailing Address - Phone:706-625-5900
Mailing Address - Fax:706-625-5906
Practice Address - Street 1:204 PROFESSIONAL CT SE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-7020
Practice Address - Country:US
Practice Address - Phone:706-625-5900
Practice Address - Fax:706-625-5906
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029271208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000350237Medicaid