Provider Demographics
NPI:1003551268
Name:WIGGINS, TAMEKIA C
Entity Type:Individual
Prefix:
First Name:TAMEKIA
Middle Name:C
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 RIDGECREST DR # 3206
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4841
Mailing Address - Country:US
Mailing Address - Phone:706-834-5779
Mailing Address - Fax:
Practice Address - Street 1:3206 RIDGECREST DR # 3206
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-4841
Practice Address - Country:US
Practice Address - Phone:706-834-5779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030050885251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health