Individual
DR. STACEY WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EMT-A
Contact information
Practice address
4 VALLEY STREAM LN, NEWNAN, GA 30263-2912
(678) 378-3195
Mailing address
4 VALLEY STREAM LN, NEWNAN, GA 30263-2912
(678) 373-9865
Taxonomy
Speciality
Code
Description
License number
State
146M00000X
Intermediate Emergency Medical Technician
Primary
A001035
GA
Other
Enumeration date
05/18/2020
Last updated
05/18/2020
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