Healthcare Provider Details

I. General information

NPI: 1922150259
Provider Name (Legal Business Name): GWENDOLYN RIGGINS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 WALNUT ST
MACON GA
31201-7307
US

IV. Provider business mailing address

PO BOX 4363
MACON GA
31208-4363
US

V. Phone/Fax

Practice location:
  • Phone: 478-787-4266
  • Fax: 478-787-4199
Mailing address:
  • Phone: 478-787-4266
  • Fax: 478-787-4199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN049330 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: