Provider Demographics
NPI:1629470125
Name:WIGGINS, ANDRONICA (NP)
Entity type:Individual
Prefix:
First Name:ANDRONICA
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MEDICAL CENTER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7765
Mailing Address - Country:US
Mailing Address - Phone:404-962-6000
Mailing Address - Fax:404-962-6001
Practice Address - Street 1:2200 MEDICAL CENTER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7765
Practice Address - Country:US
Practice Address - Phone:404-962-6000
Practice Address - Fax:404-962-6001
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN165716363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003154983CMedicaid
GA003154983AMedicaid
GA003154983AMedicaid