Healthcare Provider Details

I. General information

NPI: 1770573552
Provider Name (Legal Business Name): RICHARD I WRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 UPPER RIVERDALE RD SW STE G
RIVERDALE GA
30274-2584
US

IV. Provider business mailing address

483 UPPER RIVERDALE RD SW STE 102
RIVERDALE GA
30274-2584
US

V. Phone/Fax

Practice location:
  • Phone: 770-996-9400
  • Fax: 770-991-2918
Mailing address:
  • Phone: 770-996-9400
  • Fax: 770-991-2918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number046927
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: