Provider Demographics
NPI:1649557448
Name:WIGGINS, O'NEAL JR
Entity Type:Individual
Prefix:MR
First Name:O'NEAL
Middle Name:
Last Name:WIGGINS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 STONES MANOR CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1570
Mailing Address - Country:US
Mailing Address - Phone:931-216-4035
Mailing Address - Fax:
Practice Address - Street 1:192 STONES MANOR CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-1570
Practice Address - Country:US
Practice Address - Phone:931-216-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)