Provider Demographics
NPI:1437288016
Name:WRIGHT, JEREMIAH HOLMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:HOLMAN
Last Name:WRIGHT
Suffix:
Gender:M
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:PO BOX 11955
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3901
Mailing Address - Country:US
Mailing Address - Phone:888-630-0845
Mailing Address - Fax:
Practice Address - Street 1:620 SKYLINE DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3901
Practice Address - Country:US
Practice Address - Phone:731-541-6174
Practice Address - Fax:731-541-8008
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN482222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1529425Medicaid
TNP01092898OtherRAILROAD MEDICARE
TN1529425Medicaid