Individual
LAURA WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1672 TANK RD, ODUM, GA 31555-7108
(912) 424-0513
Mailing address
1672 TANK RD, ODUM, GA 31555-7108
(912) 424-0513
Taxonomy
Speciality
Code
Description
License number
State
2471M2300X
Mammography Radiologic Technologist
Primary
265463
GA
Other
Enumeration date
11/19/2014
Last updated
11/19/2014
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