Healthcare Provider Details

I. General information

NPI: 1124517016
Provider Name (Legal Business Name): BRANDON WRIGHT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2018
Last Update Date: 01/07/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2144 WINSOR HILLS DR
COLUMBIA SC
29204-3144
US

IV. Provider business mailing address

300 S SKYLOFT DR APT 203
ASHEVILLE NC
28801-0104
US

V. Phone/Fax

Practice location:
  • Phone: 770-823-7190
  • Fax:
Mailing address:
  • Phone: 770-823-7190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number307427
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: