Healthcare Provider Details

I. General information

NPI: 1730006776
Provider Name (Legal Business Name): MR. CORION ATAE CLARK-WRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 SPUR 138
JONESBORO GA
30236-2419
US

IV. Provider business mailing address

429 CANOGA CT
MCDONOUGH GA
30253-8669
US

V. Phone/Fax

Practice location:
  • Phone: 470-883-2810
  • Fax:
Mailing address:
  • Phone: 470-883-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-480104
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: