Provider Demographics
NPI:1700389558
Name:WIGGINS, CHRISTINE L
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
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 1:1154 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-4223
Mailing Address - Country:US
Mailing Address - Phone:478-741-7590
Mailing Address - Fax:
Practice Address - Street 1:1154 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-4223
Practice Address - Country:US
Practice Address - Phone:478-741-7590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility