Provider Demographics
NPI:1336390871
Name:WASHINGTON COUNTY INTERNAL MEDICINE, P.C.
Entity Type:Organization
Organization Name:WASHINGTON COUNTY INTERNAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:O
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-552-0001
Mailing Address - Street 1:501 SPARTA RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-1371
Mailing Address - Country:US
Mailing Address - Phone:478-552-0001
Mailing Address - Fax:478-552-0048
Practice Address - Street 1:2257 W ELM ST
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31096-2056
Practice Address - Country:US
Practice Address - Phone:478-864-0032
Practice Address - Fax:478-864-1220
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON COUNTY INTERNAL MEDICINE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55001039AMedicaid
GA55001039AMedicaid
GA55001039AMedicaid