Individual ProviderChristy WagnerFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address1856-14 Thompson Bridge Rd, Gainesville, GA 30501-1663(770) 534-2800(770) 219-8420PECOS EnrollmentBased on the most recent information from CMS, provider Christy Wagner is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1790778033Provider TypeIndividualFull NameWagner, ChristyCredentialMDGenderFemaleSole ProprietorNoEnumeration Date8/23/2005Last Updated10/13/2020Contact InformationPractice LocationPractice Address1856-14 Thompson Bridge Rd, Gainesville, GA 30501-1663Phone(770) 534-2800Fax(770) 534-2889Mailing LocationMailing AddressPO Box 742616, Atlanta, GA 30374-2616Phone(770) 219-8420Fax(770) 219-8440Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense050067GeorgiaProvider IdentifiersIDDescriptionIssuerID000907409BDescriptionMedicaidIssuerUnlistedGeorgia