MEDICARE: DR. JOHN WALLACE WRIGHT D.P.M.,P.C.

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	213E00000X	Podiatrist	575	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	016-004067	OTHER	IL	ILLINOIS LICENSE#
3	80095	OTHER	MS	MISSISSIPPI LICENSE#
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1124171251	OTHER	GA	ORGANIZATIONAL NPI
6	575	OTHER	GA	GEORGIA LICENSE#

General Provider Information

NPI Number	:	1508861493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WALLACE WRIGHT D.P.M.,P.C.

Provider Business Mailing Address
First Line	:	151 N JEFFERSON ST NE
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-3415
Country	:	US
Telephone Number	:	478-452-7342
Fax Number	:	478-452-7342

Provider Business Practice Location Address
First Line	:	151 N JEFFERSON ST NE
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-3415
Country	:	US
Telephone Number	:	478-452-7342
Fax Number	:	478-452-7342

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	03/07/2023

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Directions to “ DR. JOHN WALLACE WRIGHT D.P.M.,P.C.” Practice Location

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