Individual
RUSSELL G WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2160 FOUNTAIN DR, SUITE D, SNELLVILLE, GA 30078-7022
(770) 982-7790
(770) 982-7795
Mailing address
2160 FOUNTAIN DR, SUITE D, SNELLVILLE, GA 30078
(770) 982-7790
(770) 982-7795
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
033740
GA
Other
Enumeration date
01/17/2006
Last updated
12/23/2013
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