| RG Wagner MD LLC | |
|
2160 Fountain Dr Suite D Snellville GA 30078-7022 | |
| (770) 982-7790 | |
| Not Available |
| Full Name | RG Wagner MD LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 2160 Fountain Dr, Snellville, Georgia |
| Authorized Official Name and Position | Russell G Wagner (M.D.) |
| Authorized Official Contact | 7709827790 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| RG Wagner MD LLC 2160 Fountain Dr Suite D Snellville GA 30078-7022 Ph: (770) 982-7790 | RG Wagner MD LLC 2160 Fountain Dr Suite D Snellville GA 30078-7022 Ph: (770) 982-7790 |
| NPI Number | 1548275415 |
|---|---|
| Provider Enumeration Date | 07/29/2006 |
| Last Update Date | 07/20/2009 |
| Medicare PECOS PAC ID | 4587769476 |
|---|---|
| Medicare Enrollment ID | O20070423000065 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548275415 | NPI | - | NPPES |
| 000418074E | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Russell G Wagner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730168832 PECOS PAC ID: 2769429307 Enrollment ID: I20050414000630 |
| Provider Name | Kimberly Rose Schiavoni |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114308475 PECOS PAC ID: 3779884606 Enrollment ID: I20151218001774 |
| Provider Name | Shannon Maria Saroka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043664998 PECOS PAC ID: 8022300086 Enrollment ID: I20160712001551 |
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D L Murray MD PC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2106 Mcgee Rd, Snellville, GA 30078 Phone: 404-549-9471 Fax: 404-549-9486 |
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