Provider Demographics
NPI:1780141903
Name:WAGNER, ANYTHONY W
Entity type:Individual
Prefix:MR
First Name:ANYTHONY
Middle Name:W
Last Name:WAGNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 S GORDON ST SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-2332
Mailing Address - Country:US
Mailing Address - Phone:404-252-1102
Mailing Address - Fax:
Practice Address - Street 1:1755 THE EXCHANGE SE STE 303
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-7403
Practice Address - Country:US
Practice Address - Phone:404-981-3573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty