Individual
DEBRA ANN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
727 SE MAIN ST, SUITE 300, SIMPSONVILLE, SC 29681-3247
(864) 522-1170
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6044
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
200500395
NC
207R00000X
Internal Medicine Physician
Primary
32275
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
322751
—
SC
05
—
89139NW
—
NC
Enumeration date
02/07/2006
Last updated
12/14/2015
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