Healthcare Provider Details

I. General information

NPI: 1669124566
Provider Name (Legal Business Name): MR. AARON WRIGHT III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3614 PANOLA RD
LITHONIA GA
30038-2733
US

IV. Provider business mailing address

3614 PANOLA RD
LITHONIA GA
30038-2733
US

V. Phone/Fax

Practice location:
  • Phone: 678-478-3866
  • Fax:
Mailing address:
  • Phone: 678-478-3866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: