Provider Demographics
NPI:1164096616
Name:WRIGHT, COURTNEY LENDORA
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LENDORA
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:PRISMA HEALTH MEDICAL GROUP FAMILY MEDICINE CENTER
Mailing Address - Street 2:3209 COLONIAL DRIVE
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-6113
Mailing Address - Fax:803-434-8478
Practice Address - Street 1:PRISMA HEALTH MEDICAL GROUP FAMILY MEDICINE CENTER
Practice Address - Street 2:3209 COLONIAL DRIVE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-6113
Practice Address - Fax:803-434-8478
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SCLL86143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program