CHARLES HERBERT WAGONER (NPI# 1174603807) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174603807 |
| Entity Type | Individual |
| Full Name | CHARLES HERBERT WAGONER |
| Credential | M.D. |
| Practice Address |
1603 S Mississippi St Crossett AR 71635-3713 |
| Mailing Address |
Po Box 246 Crossett AR 71635-0246 |
| Practice Telephone | 8703644631 |
| Mailing Telephone | 8703644631 |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
82164 | MA | Allopathic & Osteopathic Physicians |
| Street Address |
1603 S MISSISSIPPI ST |
| City | CROSSETT |
| State | AR |
| Zip Code | 71635-3713 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861873929 | Kayley A Harris | Social Worker | 1308 West 5th, Crossett, AR 71635 | 2015-06-15 |
| 1134552136 | Shonta G. Paskel | Licensed Practical Nurse | 1308 W. 5th Street, Crossett, AR 71635 | 2013-08-13 |
| 1861708885 | Stonegate Villa Health and Rehabilitation LLC | Skilled Nursing Facility | 118 Jerry Selby Drive, Crossett, AR 71635 | 2010-08-27 |
| 1457688673 | Crystal L Pippen | Case Manager/Care Coordinator | 1308 W. 5th St., Crossett, AR 71635 | 2009-11-09 |
| 1851526602 | Paula Aletha Wall | Case Manager/Care Coordinator | 1802 Hwy 82 West, Crossett, AR 71635 | 2009-05-22 |
| 1982855979 | Megan T Harris | Counselor | 615 W 1st Avenue, Crossett, AR 71635 | 2008-10-08 |
| 1063661882 | Helen Davis | Social Worker | 1308 W 5th Street, Crossett, AR 71635 | 2008-09-17 |
| 1043469869 | Shajuana Brown | Social Worker | 1308 West 5th St., Crossett, AR 71635 | 2008-09-17 |
| 1750537387 | Wanda F Hicks | Licensed Practical Nurse | 1308 West 5th Ave, Crossett, AR 71635 | 2008-08-14 |
| 1760654156 | John R Garlington | Psychologist | 1308 West 5th Street, Crossett, AR 71635 | 2008-03-26 |
| Find all providers in zip 71635 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
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| 1528668357 | Medical Associates of Northwest Arkansas, Pa | Radiology | 3901 Parkway Cir Ste 125, Springdale, AR 72762-6362 | 2020-10-30 |
| 1144853821 | Resort Radiology, Pllc | Radiology | 13107 Colonel Glenn Rd, Little Rock, AR 72210-2319 | 2020-02-20 |
| 1548813793 | Medcom Imaging, Inc. | Radiology | 11 Sherwood Ln, Clarksville, AR 72830-4500 | 2019-07-17 |
| 1750848552 | Tamesha Green | Radiology | 3204 Salinas De Hidalgo, North Little Rock, AR 72118-1167 | 2019-02-27 |
| 1598243560 | Medical Associates of Northwest Arkansas Pa | Radiology | 502 N Walnut St, Harrison, AR 72601-3616 | 2018-08-01 |
| 1932694692 | Healthstar Physicians of Hot Springs, Pllc | Radiology | 120 Adcock Rd Ste B, Hot Springs, AR 71913 | 2018-06-26 |
| 1245626704 | Michael Platt | Radiology | 15 W Nottingham Ln, Rogers, AR 72758-9513 | 2015-04-11 |
| 1578982526 | John Clifton Faircloth | Radiology | 800 S Chuch St, Suite 101, Jonesboro, AR 72401 | 2014-04-07 |
| 1700211653 | Medical Associates of Northwest Arkansas Pa | Radiology | 3383 N Mana Ct Ste 102, Fayetteville, AR 72703-4965 | 2013-09-11 |
| 1083053615 | Caraway Medical Center | Radiology | 2929 S Caraway Rd Ste 1, Jonesboro, AR 72401-7335 | 2013-06-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.