Individual
LAUREN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
777 HEMLOCK ST, MSC 42, MACON, GA 31201-2102
(478) 633-7600
(478) 633-7354
Mailing address
777 HEMLOCK ST # 117, MACON, GA 31201-2102
(478) 633-1000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
77978
GA
Other
Enumeration date
05/14/2014
Last updated
08/19/2020
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