Provider Demographics
NPI:1376594101
Name:WIGGINS, JANICE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:M
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JANICE
Other - Middle Name:M
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:100 PALMETTO HEALTH PKWY STE 220
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1755
Practice Address - Country:US
Practice Address - Phone:803-749-0693
Practice Address - Fax:414-527-8046
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41793207Q00000X
SC40772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
006000215JOtherHUMANA
SC407722Medicaid
WI1376594101Medicaid
SC407722Medicaid
006000215JOtherHUMANA