Provider Demographics
NPI:1386642684
Name:WRIGHT, WENDY LATRICE (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LATRICE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3579 HIGHWAY 138 SE STE 103
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4127
Mailing Address - Country:US
Mailing Address - Phone:770-629-4374
Mailing Address - Fax:678-545-1735
Practice Address - Street 1:3579 HIGHWAY 138 SE STE 103
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4127
Practice Address - Country:US
Practice Address - Phone:770-629-4374
Practice Address - Fax:678-545-1735
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202639392OtherTIN
GA08BBRQWMedicare ID - Type UnspecifiedMEDICARE
GAH85446Medicare UPIN