Healthcare Provider Details

I. General information

NPI: 1790471118
Provider Name (Legal Business Name): LEVON WRIGHT III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 GRELOT RD STE G1016
MOBILE AL
36609-3602
US

IV. Provider business mailing address

6300 GRELOT RD STE G1016
MOBILE AL
36609-3602
US

V. Phone/Fax

Practice location:
  • Phone: 850-529-1877
  • Fax:
Mailing address:
  • Phone: 850-529-1877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLXW-0109-8730
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: