| Doctor Name: | DR. MICHAEL WILLIAM WAGER |
| NPI Number: | 1073642070 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 002266 |
| Business Practice Address: | 602 Victoria Pl Thomasville, GA - 317926686 |
| Business Phone Number: | 2292289066 |
| Business Fax Number: | 2292285158 |
| Mailing Address: | 641 N Pinetree Blvd, THOMASVILLE |
| State: | GA |
| Postal Code: | 317923903 |
| Phone Number: | 2292289066 |
| Fax Number: | 2292285158 |
| NPI Enumeration Date: | 03/05/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 002266 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |