Provider Demographics
NPI:1376150987
Name:WRIGHT, GERALD ADRIAN JR
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ADRIAN
Last Name:WRIGHT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300185
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38130-0185
Mailing Address - Country:US
Mailing Address - Phone:901-406-3670
Mailing Address - Fax:
Practice Address - Street 1:3400 JENKINS ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-5204
Practice Address - Country:US
Practice Address - Phone:901-406-3670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN200008503347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker