Individual
MISS MYESHA J. WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
36 LINDEN AVE NW, ATLANTA, GA 30308
(404) 778-0278
(404) 686-8266
Mailing address
36 LINDEN AVE NE, ATLANTA, GA 30308-2951
(404) 778-8266
(404) 686-8266
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN258179
GA
363LF0000X
Family Nurse Practitioner
RN258179
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003274648A
—
GA
01
—
G34406A
MEDICARE PTAN
GA
Enumeration date
06/20/2022
Last updated
10/15/2025
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