Healthcare Provider Details

I. General information

NPI: 1447352570
Provider Name (Legal Business Name): MONICA K. WRIGHT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MARTIN LUTHER KING JR BLVD
MACON GA
31201
US

IV. Provider business mailing address

250 MARTIN LUTHER KING JR BLVD
MACON GA
31201
US

V. Phone/Fax

Practice location:
  • Phone: 478-301-4111
  • Fax:
Mailing address:
  • Phone: 478-301-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number871
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004265
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: