| Heather Wagner, | |
|
470 Northside Cherokee Blvd Ste 201, Canton, GA 30115-8029 | |
| (770) 720-7246 | |
| (770) 720-4620 |
| Full Name | Heather Wagner |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant |
| Location | 470 Northside Cherokee Blvd Ste 201, Canton, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336903319 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 12364 (Georgia) | Primary |
| Entity Name | Georgia Urology, PA |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1245250646 PECOS PAC ID: 8921094376 Enrollment ID: O20040422000123 |
| Entity Name | Urological Professional Services, LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1033521810 PECOS PAC ID: 9638391717 Enrollment ID: O20141104002579 |
| Entity Name | Walker Lake Emergency Group PC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1437629342 PECOS PAC ID: 0840531919 Enrollment ID: O20190418001186 |
| Mailing Address | Practice Location Address |
|---|---|
| Heather Wagner, 1930 Brannan Rd, Mcdonough, GA 30253-4310 Ph: (678) 284-4040 | Heather Wagner, 470 Northside Cherokee Blvd Ste 201, Canton, GA 30115-8029 Ph: (770) 720-7246 |
Uma T Daya, P.A. Physician Assistant Medicare: Medicare Enrolled Practice Location: 220 Oakside Ln, Canton, GA 30114 Phone: 678-807-1050 Fax: 770-720-7384 |
Alyssa Giardina, Physician Assistant Medicare: Medicare Enrolled Practice Location: 216 Moore Valley Way, Canton, GA 30115 Phone: 678-710-1312 |
Mr. Colin Flanagan, PS-S Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 150 Cedar Woods Trl, Canton, GA 30114 Phone: 631-807-5906 |
Brittany Marie Stento, PAC Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 470 Northside Cherokee Blvd Ste 230, Canton, GA 30115 Phone: 770-924-9656 |
Daniel Todd Cannon, Physician Assistant Medicare: Medicare Enrolled Practice Location: 1521 Hickory Flat Hwy Ste 200, Canton, GA 30115 Phone: 470-297-1310 |
Mrs. Kirby Brown Reinecke, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 120 Oakside Ct, Suite H, Canton, GA 30114 Phone: 678-880-8770 Fax: 770-213-4418 |
Richard F Hamaker, P.A. Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 220 Oakside Ln, Canton, GA 30114 Phone: 678-807-1050 Fax: 678-807-1055 |