Healthcare Provider Details

I. General information

NPI: 1104751395
Provider Name (Legal Business Name): NORMA ELAINE WIGGINS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E 40TH ST
SAVANNAH GA
31401-9116
US

IV. Provider business mailing address

PO BOX 15154
SAVANNAH GA
31416-1854
US

V. Phone/Fax

Practice location:
  • Phone: 912-429-3424
  • Fax:
Mailing address:
  • Phone: 912-429-3424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT005181
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: