Provider Demographics
NPI:1952872129
Name:WIGGINS, JOHN FRANK JR
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FRANK
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 1:165 SWEETHOME RD
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-6847
Mailing Address - Country:US
Mailing Address - Phone:662-809-8901
Mailing Address - Fax:662-307-2728
Practice Address - Street 1:165 SWEETHOME RD
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-6847
Practice Address - Country:US
Practice Address - Phone:662-809-8901
Practice Address - Fax:662-307-2728
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)