Individual
CODY ROBERT WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
41 PARK CREEK DR, GREENVILLE, SC 29605-4270
(803) 299-4000
Mailing address
589 PINELAND MEADOWS RD, BELTON, SC 29627-8205
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
18300
SC
Other
Enumeration date
01/09/2026
Last updated
01/09/2026
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