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Individual

DR. CASEY WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
7813 SPIVEY STATION BLVD STE 220, JONESBORO, GA 30236
(404) 778-3350
Mailing address
7813 SPIVEY STATION BLVD STE 220, JONESBORO, GA 30236-2900

Taxonomy

Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
82480
GA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
E9863
AR

Other

Enumeration date
06/15/2012
Last updated
08/12/2019
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