MEDICARE: JOHN WALLACE WRIGHT,DPM,PC

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
1	213E00000X	Podiatrist	575	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1508861493	OTHER	GA	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1124171251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN WALLACE WRIGHT,DPM,PC

Provider Business Mailing Address
First Line	:	151 N JEFFERSON ST NE
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-3415
Country	:	US
Telephone Number	:	478-452-7342
Fax Number	:	478-452-7342

Provider Business Practice Location Address
First Line	:	151 N JEFFERSON ST NE
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-3415
Country	:	US
Telephone Number	:	478-452-7342
Fax Number	:	478-452-7342

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	DR. JOHN WALLACE WRIGHT
Credential	:	DPM
Telephone Number	:	478-452-7342

Provider Enumeration Date	:	01/20/2007
Last Update Date	:	01/11/2010

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