Individual
JERRY MARK WIGLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
179B PINE GROVE RD., CARTERSVILLE, GA 30120
(770) 387-4544
(770) 387-4579
Mailing address
179B PINE GROVE RD, CARTERSVILLE, GA 30120
(770) 387-4544
(770) 387-4579
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
034078
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000463152C
—
GA
Enumeration date
07/19/2006
Last updated
09/16/2013
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