Individual
DR. WIGBERTO VIVAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
620 BROAD ST, MILLEDGEVILLE, GA 31062-7525
(478) 445-4128
Mailing address
620 BROAD ST, MILLEDGEVILLE, GA 31062-7525
(478) 445-4128
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
022662
GA
Other
Enumeration date
12/05/2007
Last updated
12/05/2007
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