Provider Demographics
NPI:1679531925
Name:HIGGINS, J. CHRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:J. CHRIS
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:CHRISTIAN
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-0407
Mailing Address - Country:US
Mailing Address - Phone:912-537-4986
Mailing Address - Fax:
Practice Address - Street 1:101 HARRIS INDUSTRIAL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8852
Practice Address - Country:US
Practice Address - Phone:912-535-3500
Practice Address - Fax:912-535-3510
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0008175174400000X, 207RC0000X
GA067463207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003135024AMedicaid
GA003135024AMedicaid
GA202I066260Medicare PIN
F22257Medicare UPIN
VT0VN0319Medicaid