Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 25607 | SC |
Y | 111NI0900X | Internist | 25607 | SC |
N | 207RH0002X | Hospice and Palliative Medicine | 203441 | LA |
NPI | 1386692036 |
---|---|
Provider Name | Rebecca Leigh Wagstaff |
First Address | Atlanta, GA 30374-3070 |
Second Address | Spartanburg, SC 29303-3040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 12/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03087834 | (05) | MS |
1811726 | (05) | LA |
256074 | (05) | SC |
3283927 | CIGNA ID (01) | SC |
576007863071 | BLUECHOICE HEALTHPLAN ID (01) | SC |
576007863095 | BCBS OF SC ID (01) | SC |
7027607 | AETNA ID (01) | SC |
I08558 | (02) | SC |
P00113665 | RR MEDICARE (01) | SC |
P01577390 | RAILROAD MEDICARE (01) | SC |
SC75725019 | MEDICARE PIN (01) | SC |
SC75729068 | (02) | SC |
SC75729068 | MEDICARE PIN (01) | SC |