Individual
HEATHER WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
470 NORTHSIDE CHEROKEE BLVD STE 201, CANTON, GA 30115-8029
(770) 720-7246
(770) 720-4620
Mailing address
1930 BRANNAN RD, MCDONOUGH, GA 30253-4310
(678) 284-4040
(678) 284-4076
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
02/09/2024
Last updated
04/16/2026
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