Healthcare Provider Details

I. General information

NPI: 1114934072
Provider Name (Legal Business Name): CARL D WRIGHT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13038 RIVERS BEND RD
CHESTER VA
23836-2564
US

IV. Provider business mailing address

131 JENNICK DR
COLONIAL HEIGHTS VA
23834-4905
US

V. Phone/Fax

Practice location:
  • Phone: 804-530-3330
  • Fax: 804-530-9998
Mailing address:
  • Phone: 804-526-5888
  • Fax: 804-526-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001332
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: