Healthcare Provider Details

I. General information

NPI: 1205756319
Provider Name (Legal Business Name): TELIA WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 ROBERTS DR
RIVERDALE GA
30274-2959
US

IV. Provider business mailing address

10669 DAY LILY DR
HAMPTON GA
30228-6139
US

V. Phone/Fax

Practice location:
  • Phone: 770-569-3144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT015429
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: