Heather Wagner

Physician Assistant · Canton, GA

Individual Active NPI

NPI number 1336903319

Practice location

470 Northside Cherokee Blvd Ste 201
Canton, GA 30115-8029
Phone
(770) 720-7246
Fax
(770) 720-4620

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NPI record

NPI
1336903319
Entity type
Individual (Type 1)
Enumeration date
February 9, 2024
Last updated
May 18, 2026
Certified
May 18, 2026
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Physician Assistant Primary 363A00000X 12364 GA

Mailing address

1930 Brannan Rd
McDonough, GA 30253-4310
Phone
(678) 284-4040
Fax
(678) 284-4076

About Heather Wagner

Heather Wagner is a healthcare provider registered in the NPI registry with the primary taxonomy Physician Assistant (code 363A00000X). The practice location is 470 Northside Cherokee Blvd Ste 201, Canton, GA 30115-8029. The NPI number 1336903319 was assigned on February 9, 2024 and the record was last updated on May 18, 2026.

Heather Wagner lists a license in the registry: #12364 (GA) for Physician Assistant. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Heather Wagner?

The NPI number is 1336903319.

What is the phone number of Heather Wagner?

The phone number listed for the practice location is (770) 720-7246.

Where is Heather Wagner located?

470 Northside Cherokee Blvd Ste 201, Canton, GA 30115-8029.

What is the taxonomy code for Heather Wagner?

The primary taxonomy code is 363A00000X – Physician Assistant.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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