Individual
JOHN ALLEN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
300 EAST HOSPITAL RD, FORT GORDON, GA 30905-5650
(706) 787-6945
Mailing address
300 EAST HOSPITAL ROAD, FORT GORDON, GA 30905-5650
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/13/2023
Last updated
04/13/2023
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