Individual
WAYNE E GRAYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
906 SIXTH AVE, PICAYUNE, MS 39466-3802
(601) 798-7529
(601) 798-7553
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 795-0659
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
06726
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04208026
—
MS
05
—
1589578
—
LA
01
—
640507572XP
AMERICAN ADMIN GROUP
MS
Enumeration date
08/09/2006
Last updated
10/31/2023
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