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General NPI Number Information
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NPI Number | 1144789298
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Entity Type | Individual
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Provider Name | JOHN DAVID WAGNER MD
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Gender | Male
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 2970 BRANDYWINE RD STE 125
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City | ATLANTA
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State | GA
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Zip | 30341-5528
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Country | US
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Telephone | 713-790-9401
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Fax |
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Provider Business Mailing Address
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Address Line | 2835 BRANDYWINE RD STE 400
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City | ATLANTA
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State | GA
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Zip | 30341-5540
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 91568
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License Number State | GA
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