Provider Demographics
NPI:1265487110
Name:WIGGANS, ROY GLEN (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:GLEN
Last Name:WIGGANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SKYLINE PKWY
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3867
Mailing Address - Country:US
Mailing Address - Phone:706-353-0497
Mailing Address - Fax:
Practice Address - Street 1:3320 OLD JEFFERSON RD
Practice Address - Street 2:BLDG. 700
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1400
Practice Address - Country:US
Practice Address - Phone:706-353-2990
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027468207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00309933AMedicaid
GAAW7595070OtherDEA
GAAW7595070OtherDEA
GA83BBBVZMedicare ID - Type Unspecified