Organization
RG WAGNER MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL G WAGNER (M.D.)
(770) 982-7790
Entity
Organization
Contact information
Practice address
2160 FOUNTAIN DR, SUITE D, SNELLVILLE, GA 30078-7022
(770) 982-7790
Mailing address
2160 FOUNTAIN DR, SUITE D, SNELLVILLE, GA 30078-7022
(770) 982-7790
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000418074E
—
GA
Enumeration date
07/29/2006
Last updated
07/20/2009
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