Provider Demographics
NPI:1003329806
Name:BRIGHT, SAMUEL AGYEI
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:AGYEI
Last Name:BRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12801 NIGHT OWL CT
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-5101
Mailing Address - Country:US
Mailing Address - Phone:703-597-4046
Mailing Address - Fax:703-597-4046
Practice Address - Street 1:12801 NIGHT OWL CT
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-5101
Practice Address - Country:US
Practice Address - Phone:703-597-4046
Practice Address - Fax:703-597-4046
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver