Provider Demographics
NPI:1093223836
Name:WRIGHT, CARLISA YVETTE
Entity Type:Individual
Prefix:
First Name:CARLISA
Middle Name:YVETTE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 FOREST HILLS PATH
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-3266
Mailing Address - Country:US
Mailing Address - Phone:678-598-5045
Mailing Address - Fax:
Practice Address - Street 1:664 FOREST HILLS PATH
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-3266
Practice Address - Country:US
Practice Address - Phone:678-598-5045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000016021374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide