Provider Demographics
NPI:1053985911
Name:SOUTH, WAYNE JOSEPH JR
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:JOSEPH
Last Name:SOUTH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 S FLAMINGO WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6804
Mailing Address - Country:US
Mailing Address - Phone:303-885-5531
Mailing Address - Fax:
Practice Address - Street 1:3032 S FLAMINGO WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6804
Practice Address - Country:US
Practice Address - Phone:303-885-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health