Basic Information
| Provider Information | |||||||||
| NPI: | 1295782753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALE | ||||||||
| FirstName: | WAYNE | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368327000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1125 N CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368328035 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 04/05/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 30355 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QG0300X | 30355 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9074 | 01 | NC | PARTNERS MEDICARE CHOICE | OTHER | 5184053 | 01 | NC | AETNA | OTHER | 38276 | 01 | NC | BCBS NC | OTHER | 8938276 | 05 | NC | MEDICAID | 24818 | 01 | NC | MEDCOST | OTHER |