Healthcare Provider Details

I. General information

NPI: 1871497552
Provider Name (Legal Business Name): JOHN ROGER WRIGHT CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 GODWIN BLVD
SUFFOLK VA
23434-8038
US

IV. Provider business mailing address

2089 MILL LAKE RD
SUFFOLK VA
23434-0001
US

V. Phone/Fax

Practice location:
  • Phone: 757-983-1402
  • Fax:
Mailing address:
  • Phone: 757-983-1402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136000492
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: