Individual
JUSTIN EDWARD WAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
415 E 4TH AVE STE C, CORDELE, GA 31015-0614
(229) 273-9320
Mailing address
105 E 4TH AVE, CORDELE, GA 31015-3262
(229) 273-9320
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN217684
GA
363LG0600X
Gerontology Nurse Practitioner
RN217684
GA
Other
Enumeration date
04/30/2015
Last updated
07/21/2025
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