Russell G Wagner, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

033740 Issued in GA

Practice address

2160 Fountain Dr
Suite D
Snellville, GA 30078-7022

Phone

(770) 982-7790

Fax

(770) 982-7795

NPI assigned

Jan 17, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• RG Wagner MD LLC

  • Internal Medicine Physician
  • Snellville, GA
  • NPI 1548275415
  Medicare reassignment NPD Authorized official
• Gary S Figiel MD PC

  dba Southeastern Geriatric Healthcare Group

  • Geriatric Psychiatry Physician
  • Atlanta, GA
  • NPI 1265591754
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387756800000",
    "number": "1730168832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 FOUNTAIN DR",
            "address_2": "SUITE D",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "30078",
            "telephone_number": "770-982-7790",
            "fax_number": "770-982-7795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 FOUNTAIN DR",
            "address_2": "SUITE D",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300787022",
            "telephone_number": "770-982-7790",
            "fax_number": "770-982-7795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "RUSSELL",
        "middle_name": "G",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-17",
        "last_updated": "2013-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "033740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Shaquinna Wadley, RBT
• Amy J Waite, MA/CCC-SLP
• Khari Waithe-Alexander, PT, DPT
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-3389)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-3072)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1720)

• Internal Medicine Physician in Snellville, GA
• Providers in Snellville, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.