| Doctor Name: | LAURA WAGGONER |
| NPI Number: | 1316344377 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 265463 |
| Business Practice Address: | 1672 Tank Rd Odum, GA - 315557108 |
| Business Phone Number: | 9124240513 |
| Business Fax Number: | |
| Mailing Address: | 1672 Tank Rd, ODUM |
| State: | GA |
| Postal Code: | 315557108 |
| Phone Number: | 9124240513 |
| Fax Number: | |
| NPI Enumeration Date: | 11/19/2014 |
| NPI Last Update Date: | 11/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471M2300X |
| License Number: | 265463 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Mammography |
| Taxonomy Definition: | |