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General NPI Number Information
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NPI Number | 1942707435
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Entity Type | Individual
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Provider Name | ANNE WILSON WAGSTAFF MD
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Gender | Female
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 1201 SAM PERRY BLVD STE 280
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-8400
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Country | US
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Telephone | 407-419-2005
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Fax |
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Provider Business Mailing Address
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Address Line | 625 19TH STREET SOUTH
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City | BIRMINGHAM
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State | AL
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Zip | 35249
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 38982
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101274454
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License Number State | VA
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