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NPI Code Detail

MEDICARE: DR. ARETHA WIGGS-GRIMES D.O.

MEDICARE: DR. ARETHA WIGGS-GRIMES D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician200301191NC
2207Q00000XFamily Medicine Physician0102201482VA
3207Q00000XFamily Medicine Physician211390NY

General Provider Information

NPI Number : 1841265550
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ARETHA WIGGS-GRIMES D.O.
Provider Business Mailing Address
First Line : 480 RUIN CREEK RD
Second Line :
City : HENDERSON
State : NC
Zip : 27536-2929
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 480 RUIN CREEK RD
Second Line :
City : HENDERSON
State : NC
Zip : 27536-2929
Country : US
Telephone Number : 252-492-3152
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 01/22/2008

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