Healthcare Provider Details

I. General information

NPI: 1477002145
Provider Name (Legal Business Name): GARNELL WRIGHTEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 PARK AVE #1101
POOLER GA
31322
US

IV. Provider business mailing address

260 PARK AVE APT 1101
POOLER GA
31322-4275
US

V. Phone/Fax

Practice location:
  • Phone: 917-645-6726
  • Fax:
Mailing address:
  • Phone: 917-645-6726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: