Healthcare Provider Details

I. General information

NPI: 1265527840
Provider Name (Legal Business Name): MICHAEL MCBREARTY WRIGHT DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 FORSYTH ST
MACON GA
31201-8423
US

IV. Provider business mailing address

1502 FORSYTH ST
MACON GA
31201-8423
US

V. Phone/Fax

Practice location:
  • Phone: 478-742-1218
  • Fax: 478-755-9679
Mailing address:
  • Phone: 478-742-1218
  • Fax: 478-755-9679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN011769
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number058033
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: