Healthcare Provider Details

I. General information

NPI: 1437582913
Provider Name (Legal Business Name): GAYLE ANNE HENDRICKS WRIGHT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS GAYLE ANNE HENDRICKS

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-1500
US

IV. Provider business mailing address

1120 15TH ST BG-2101A
AUGUSTA GA
30912-5563
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-9442
  • Fax: 706-721-9463
Mailing address:
  • Phone: 706-721-9442
  • Fax: 706-721-9463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number009081
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number009081
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: