Healthcare Provider Details

I. General information

NPI: 1053486126
Provider Name (Legal Business Name): TRAVIS F. WIGGINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 STEPHENSON AVE
SAVANNAH GA
31405-5969
US

IV. Provider business mailing address

519 STEPHENSON AVE
SAVANNAH GA
31405-5969
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-9447
  • Fax:
Mailing address:
  • Phone: 912-354-9447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL27172
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number65917
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: