Provider Demographics
NPI:1386075612
Name:WAYNE HEALTH FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:WAYNE HEALTH FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:919-587-4081
Mailing Address - Street 1:PO BOX 1717
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27533-1717
Mailing Address - Country:US
Mailing Address - Phone:919-587-4081
Mailing Address - Fax:919-587-0775
Practice Address - Street 1:210 N HERMAN ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3810
Practice Address - Country:US
Practice Address - Phone:919-587-4081
Practice Address - Fax:919-587-0775
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAYNE HEALTH PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-12
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty