Healthcare Provider Details

I. General information

NPI: 1811746639
Provider Name (Legal Business Name): VICTORIA HOCKADAY WIGGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 UNION AVE STE C211
MEMPHIS TN
38103-3513
US

IV. Provider business mailing address

395 S HIGHLAND ST APT 337
MEMPHIS TN
38111-1597
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-1731
  • Fax:
Mailing address:
  • Phone: 731-234-1566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12521
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: