Individual
JOSEPH WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
503 THOMPSON ST, GAFFNEY, SC 29340-3619
(864) 761-6642
Mailing address
4042 WALLOON LN APT 311, SPARTANBURG, SC 29301-6626
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1675
SC
2255A2300X
Athletic Trainer
2601002742
MI
Other
Enumeration date
01/23/2023
Last updated
02/09/2025
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