Dr Robert Jay Wagner, MD | |
117 Kite Rd, Swainsboro, GA 30401-3231 | |
(478) 289-1100 | |
(478) 289-1300 |
Full Name | Dr Robert Jay Wagner |
---|---|
Gender | Male |
Speciality | Emergency Medicine |
Location | 117 Kite Rd, Swainsboro, Georgia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1033278684 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207P00000X | Emergency Medicine | ME152768 (Florida) | Primary |
207P00000X | Emergency Medicine | 043503 (Georgia) | Secondary |
Entity Name | Wayne Emergency Group Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1982828943 PECOS PAC ID: 6103926241 Enrollment ID: O20070703000148 |
Entity Name | Montgomery Emergency Group, Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1861773764 PECOS PAC ID: 5395918387 Enrollment ID: O20111108000598 |
Entity Name | Erx Group Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1760823082 PECOS PAC ID: 9335037571 Enrollment ID: O20130930000326 |
Mailing Address | Practice Location Address |
---|---|
Dr Robert Jay Wagner, MD Po Box 879, Swainsboro, GA 30401-0879 Ph: (478) 289-1100 | Dr Robert Jay Wagner, MD 117 Kite Rd, Swainsboro, GA 30401-3231 Ph: (478) 289-1100 |
Gregory Max Pyne, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 117 Kite Rd, Swainsboro, GA 30401 Phone: 478-289-1349 Fax: 478-289-1300 | |
Bobby Lee Derrick, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 117 Kite Rd, Swainsboro, GA 30401 Phone: 478-289-1368 Fax: 478-289-1300 | |
Dr. S Diane Rickert, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 117 Kite Rd, Swainsboro, GA 30401 Phone: 478-289-1100 | |
Joseph Obebe, D.O. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 117 Kite Rd, Swainsboro, GA 30401 Phone: 478-289-1100 | |
Eric G. Fogam, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 117 Kite Rd, Swainsboro, GA 30401 Phone: 478-289-1349 Fax: 478-289-1300 |