# SCOTT WAGNER INTEGRATED MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447875042
- **Authorized official:** SCOTT BRIAN WAGNER DC (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (434) 978-4888

## Contact information

- **Practice address:** 2109 INDIA RD, CHARLOTTESVILLE, VA 22901-2886
- **Practice address phone:** (434) 978-4888
- **Mailing address:** 2109 INDIA RD, CHARLOTTESVILLE, VA 22901-2886
- **Mailing address phone:** (434) 978-4888
- **Mailing address fax:** (434) 978-3633

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/10/2020
- **Last updated:** 06/20/2023