Individual
ROBERTA DOREEN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
4331 THURMON TANNER RD, FLOWERY BRANCH, GA 30542-2829
(678) 513-5700
Mailing address
4331 THURMON TANNER RD, FLOWERY BRANCH, GA 30542-2829
(678) 513-5700
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN071643
GA
Other
Enumeration date
07/10/2009
Last updated
07/10/2009
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