Provider Demographics
NPI:1104030824
Name:WIGGINS FOOT AND ANKLE ASSOCIATES P.C.
Entity Type:Organization
Organization Name:WIGGINS FOOT AND ANKLE ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:912-537-2559
Mailing Address - Street 1:205 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-7209
Mailing Address - Country:US
Mailing Address - Phone:912-537-2559
Mailing Address - Fax:912-537-9668
Practice Address - Street 1:205 ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-7209
Practice Address - Country:US
Practice Address - Phone:912-537-2559
Practice Address - Fax:912-537-9668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000802213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00725018AMedicaid
DG1916OtherRR MCR
GRP6244Medicare PIN
GA00725018AMedicaid
GAU63701Medicare UPIN