DR. CASEY WAGNER (NPI# 1306108279) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306108279 |
| Entity Type | Individual |
| Full Name | DR. CASEY WAGNER |
| Credential | M.D. |
| Practice Address |
7813 Spivey Station Blvd Ste 220 Jonesboro GA 30236 |
| Mailing Address |
7813 Spivey Station Blvd Ste 220 Jonesboro GA 30236-2900 |
| Practice Telephone | 4047783350 |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2019-08-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
82480 | GA | Allopathic & Osteopathic Physicians |
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
E9863 | AR | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1364 Clifton Rd Ne, Atlanta, GA 303221064 | 4047122000 | |
| 3900 N Parkview Dr, Fayetteville, AR 727036398 | 4799664187 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740777838 | Casey Wagner | Social Worker | 7115 Forthun Rd Ste 105, Baxter, MN 56425 | 2018-04-16 |
| 1750659777 | Casey Rae Wagner | Nurse Practitioner | 5325 Faraon St., St. Joseph, MO 64506-3488 | 2011-12-05 |
| 1306094891 | Casey Wagner | Case Manager/Care Coordinator | 118 Maple Ave, Bellefontaine, OH 43311-0670 | 2008-09-09 |
| Street Address |
7813 SPIVEY STATION BLVD STE 220 |
| City | JONESBORO |
| State | GA |
| Zip Code | 30236 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972123362 | Life Source Counseling & Consulting, LLC | Clinic/Center | 118 North Avenue, Suite A, Jonesboro, GA 30236 | 2020-04-25 |
| 1639609555 | New Beginnings Behavioral Counseling,llc | Social Worker | 9456 S Main St Ste E2, Jonesboro, GA 30236 | 2017-06-13 |
| 1437696762 | Clarissa Alexandra Poole | Counselor | 2106 Fair Ridge Ct, Jonesboro, GA 30236 | 2017-01-25 |
| 1588012892 | Sundance Healthcare Service Inc | In Home Supportive Care | 7861 Collinswood Court, Jonesboro, GA 30236 | 2016-05-26 |
| 1942669205 | Adrianne Smiley Gurley | Occupational Therapist | 1299 Battlecreek Rd Ste 210, Jonesboro, GA 30236 | 2016-02-15 |
| 1336505809 | Integrated Health Center | Dentist | 8600 Tara Blvd, Suite D, Jonesboro, GA 30236 | 2016-01-13 |
| 1467827402 | Surrell Porter | Nurse Practitioner | 1287 Georgia Highway 138 Spur, Suite 8, Jonesboro, GA 30236 | 2015-12-02 |
| 1740688910 | Jacqueline Carolyn Edwards | Registered Nurse | 8081 Tara Blvd, 265, Jonesboro, GA 30236 | 2014-12-19 |
| 1770991861 | Lower Extremity Diagnostics, LLC | Podiatrist | 6911 Tara Boulevard, Jonesboro, GA 30236 | 2014-08-01 |
| 1760899710 | Fresenius Medical Care Jonesboro, LLC | Clinic/Center | 8060 Summitt Business Parkway, Jonesboro, GA 30236 | 2014-07-22 |
| Find all providers in zip 30236 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962841155 | Bhavesh Joshi | Family Medicine | 2405 Aggie Road, Jonesboro, AR 72401 | 2013-06-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831422682 | Koji Nishimura | Family Medicine | Commander, Usameddac and Martin Army Community Hospital, 7950 Martin Loop, Fort Benning, GA 31905 | 2009-09-11 |
| 1073787305 | Mark James Sakr | Family Medicine | 3400 Old Milton Pkwy Ste C190, Alpharetta, GA 30005-4481 | 2008-04-17 |
| 1104009059 | Northeast Georgia Physicians Group, Inc. | Family Medicine | 115 Towne Center Pkwy, Suite 113, Hoschton, GA 30548-2213 | 2007-12-14 |
| 1366549073 | Michael Joseph Huey | Family Medicine | Emory University Student Health Services, 1525 Clifton Road, Atlanta, GA 30322-0001 | 2006-09-17 |
| 1942234281 | Charles Edward Garten II | Family Medicine | 3200 Downwood Cir Nw Ste 340, Atlanta, GA 30327-1605 | 2006-07-11 |
| 1477597979 | John M. Henderson Sr. | Family Medicine | 1900 10th Ave Suite 320, Columbus, GA 31901 | 2006-06-15 |
| 1609843481 | Tracy R Ray | Family Medicine | 1305 Jennings Mill Rd Ste 110, Watkinsville, GA 30677-7241 | 2006-03-01 |
| 1982679684 | John Michael Buchanan | Family Medicine | 3575 Braselton Hwy, Dacula, GA 30019-1155 | 2006-02-17 |
| 1770562852 | Neeru Jayanthi | Family Medicine | 6335 Hospital Pkwy Ste 302, Emory Orthopaedics, Sports, Spine, Johns Creek, GA 30097-5712 | 2006-01-17 |
| 1255972840 | Chelsey Beckham | Family Medicine | 400 Arnold Mill Rd, Woodstock, GA 30188-2834 | 2019-10-04 |
| 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.