Individual
DAVONIA NICOLE WAGNER MICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
495 ARBOR HILL RD STE M, KERNERSVILLE, NC 27284-3335
(336) 883-0029
Mailing address
507 N LINDSAY ST, HIGH POINT, NC 27262-4303
(336) 883-0029
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
200300848
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5906844
—
NC
Enumeration date
12/12/2006
Last updated
05/18/2021
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