Individual
WILLIAM VAN WAGSTAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1984 PEACHTREE RD NW STE 505, ATLANTA, GA 30309-5219
(877) 263-8651
Mailing address
PO BOX 2326, INDIANAPOLIS, IN 46206-2326
(877) 263-8651
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
94776
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/17/2017
Last updated
06/21/2023
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