Healthcare Provider Details

I. General information

NPI: 1063376119
Provider Name (Legal Business Name): DIONNA WAINWRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 BRANDYWINE DR
COLUMBUS GA
31907-6707
US

IV. Provider business mailing address

1865 LIBERTY CHURCH RD
HEPHZIBAH GA
30815-4420
US

V. Phone/Fax

Practice location:
  • Phone: 443-617-5753
  • Fax:
Mailing address:
  • Phone: 443-619-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: