Healthcare Provider Details

I. General information

NPI: 1396577862
Provider Name (Legal Business Name): DAVID ANTHONY WRIGHT MBA, MHSA, MM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 HUNTCLIFF STE 1270
ATLANTA GA
30350-1809
US

IV. Provider business mailing address

113 ASHBURY DR
VILLA RICA GA
30180-2541
US

V. Phone/Fax

Practice location:
  • Phone: 404-341-6360
  • Fax:
Mailing address:
  • Phone: 207-749-0236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174V00000X
TaxonomyClinical Ethicist
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: