Individual
MR. JOHNNY WAYNE BAGWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 POOLE DR, GARNER, NC 27529-5207
(919) 779-1440
(919) 662-0613
Mailing address
801 POOLE DR, GARNER, NC 27529-5207
(919) 779-1440
(919) 662-0613
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23249
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8912480
—
NC
Enumeration date
04/04/2006
Last updated
10/22/2009
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