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General NPI Number Information
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NPI Number | 1629792932
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Entity Type | Individual
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Provider Name | DWAYNE COWLES WRIGHT MS, MED, PHD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2022
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 4210 COLUMBIA RD
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City | MARTINEZ
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State | GA
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Zip | 30907-0401
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Country | US
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Telephone | 706-364-6576
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Fax |
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Provider Business Mailing Address
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Address Line | 3874 APPALOOSA TRL
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-7206
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Country | US
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Telephone | 216-262-2474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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