Provider Demographics
NPI:1629821798
Name:WIGGINS, GZAL
Entity Type:Individual
Prefix:
First Name:GZAL
Middle Name:
Last Name:WIGGINS
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 1:1540 OAKHILL DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-3244
Mailing Address - Country:US
Mailing Address - Phone:404-401-2998
Mailing Address - Fax:
Practice Address - Street 1:1540 OAKHILL DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:GA
Practice Address - Zip Code:30011-3244
Practice Address - Country:US
Practice Address - Phone:855-832-6767
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABACB997810106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician