Provider Demographics
NPI:1093151110
Name:BIGBY, IRISH R
Entity Type:Individual
Prefix:MS
First Name:IRISH
Middle Name:R
Last Name:BIGBY
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 1:354 MARIGNA AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30079-1744
Mailing Address - Country:US
Mailing Address - Phone:678-334-9853
Mailing Address - Fax:
Practice Address - Street 1:354 MARIGNA AVE
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:GA
Practice Address - Zip Code:30079-1744
Practice Address - Country:US
Practice Address - Phone:678-334-9853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00232965171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor