Healthcare Provider Details

I. General information

NPI: 1285686865
Provider Name (Legal Business Name): JIMMIE WAYNE RIGGINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 METROMEDICAL DR
FAYETTEVILLE NC
28304-3861
US

IV. Provider business mailing address

1726 METROMEDICAL DR
FAYETTEVILLE NC
28304-3861
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-2284
  • Fax: 910-484-1673
Mailing address:
  • Phone: 910-484-2284
  • Fax: 910-484-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number9801752
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: