MEDICARE: JOHN COLEMAN WRIGHT, JR. FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1497033583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN COLEMAN WRIGHT, JR. FOUNDATION

Provider Business Mailing Address
First Line	:	165 SOUTHFIELD DR
Second Line	:
City	:	NEWNAN
State	:	GA
Zip	:	30265-1943
Country	:	US
Telephone Number	:	678-850-9589
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 SOUTHFIELD DR
Second Line	:
City	:	NEWNAN
State	:	GA
Zip	:	30265-1943
Country	:	US
Telephone Number	:	678-850-9589
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/VICE PRESIDENT
Name	:	MS. CAROL WRIGHT HOVEY
Credential	:	MED
Telephone Number	:	678-850-9589

Provider Enumeration Date	:	07/25/2011
Last Update Date	:	07/25/2011

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