Provider Demographics
NPI:1114589595
Name:WRIGHT, MANDI MARION (FNP)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:MARION
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MANDI
Other - Middle Name:MARION
Other - Last Name:CALHOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2132 OLD LOUISVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SOPERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30457-6450
Mailing Address - Country:US
Mailing Address - Phone:478-299-3851
Mailing Address - Fax:
Practice Address - Street 1:117 KIGHT ROAD
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401
Practice Address - Country:US
Practice Address - Phone:478-289-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN240130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily