Individual
KENNETH WAYNE WADDELL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
120 N LEE ST STE A, FORSYTH, GA 31029
(478) 994-0437
Mailing address
120 N LEE ST STE A, FORSYTH, GA 31029-2122
(478) 994-0437
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN249530
GA
Other
Enumeration date
07/17/2018
Last updated
07/18/2018
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