Individual
MR. RODGER KEITH WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
2405 OSLER CT, ALBANY, GA 31707-0214
(229) 435-1458
(229) 317-2342
Mailing address
PO BOX 70969, ALBANY, GA 31708-0969
(229) 435-1458
(229) 317-2342
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
006662
GA
Other
Enumeration date
11/06/2012
Last updated
02/12/2016
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