Provider Demographics
NPI:1033145313
Name:WASHINGTON COUNTY INTERNAL MEDICINE, P.C.
Entity Type:Organization
Organization Name:WASHINGTON COUNTY INTERNAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:O
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-552-0001
Mailing Address - Street 1:501 SPARTA RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-1371
Mailing Address - Country:US
Mailing Address - Phone:478-552-0001
Mailing Address - Fax:478-552-0048
Practice Address - Street 1:501 SPARTA RD
Practice Address - Street 2:SUITE F
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1371
Practice Address - Country:US
Practice Address - Phone:478-552-0001
Practice Address - Fax:478-552-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55001039AMedicaid
GA55001039AMedicaid
GA=========OtherTAX ID