Individual
AMANDA DEAN WIGGINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-AA
Contact information
Practice address
1968 PEACHTREE RD., NW, ATLANTA, GA 30309-1281
(404) 351-1745
(404) 351-7121
Mailing address
2608 DREW VALLEY RD NE, BROOKHAVEN, GA 30319-3928
(404) 578-5860
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
006200
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003113410A
—
GA
Enumeration date
07/07/2011
Last updated
05/03/2017
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