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General NPI Number Information
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NPI Number | 1770780686
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Entity Type | Individual
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Provider Name | MARCUS M WAGNER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 605 GLENWOOD DRIVE SUITE 200
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City | CHATTANOOGA
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State | TN
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Zip | 37404-1130
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Country | US
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Telephone | 423-698-1844
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Fax | 423-624-2226
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Provider Business Mailing Address
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Address Line | PO BOX 440100
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City | NASHVILLE
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State | TN
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Zip | 37244-0100
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Country | US
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Telephone | 423-698-1844
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Fax | 423-624-2226
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | TRN11513
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 48652
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License Number State | TN
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