Healthcare Provider Details

I. General information

NPI: 1952339756
Provider Name (Legal Business Name): CAROL ANN WIGGINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PEACHTREE ST. NW SUITE 720
ATLANTA GA
30309-2511
US

IV. Provider business mailing address

1800 PEACHTREE ST. NW SUITE 720
ATLANTA GA
30309-2511
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-7520
  • Fax: 404-355-2048
Mailing address:
  • Phone: 404-351-7520
  • Fax: 404-355-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number027134
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: