Provider Demographics
NPI:1043740178
Name:WRIGHT, TILDON JERROID (LCSW)
Entity Type:Individual
Prefix:
First Name:TILDON
Middle Name:JERROID
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 DECATUR ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1848
Mailing Address - Country:US
Mailing Address - Phone:678-843-8600
Mailing Address - Fax:678-843-8601
Practice Address - Street 1:275 PRYOR ST SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3638
Practice Address - Country:US
Practice Address - Phone:678-843-8840
Practice Address - Fax:678-843-8898
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0060991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical