Provider Demographics
NPI:1053838391
Name:ALBRIGHT, JOHN ROBERT (LAC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:ALBRIGHT
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:ROBERT
Other - Last Name:ALBRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SOLE MBR
Mailing Address - Street 1:185 CONRAD DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-2104
Mailing Address - Country:US
Mailing Address - Phone:706-340-3713
Mailing Address - Fax:
Practice Address - Street 1:185 CONRAD DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2104
Practice Address - Country:US
Practice Address - Phone:706-340-3713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000380171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist