Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 140155 | GA |
NPI | 1013289453 |
---|---|
Provider Name | Ms. Penny E. Wiggins |
First Address | Milledgeville, GA 31061-4952 |
Second Address | Milledgeville, GA 31061-4881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2012 |
Last Update Date | 16/08/2016 |