Provider Demographics
NPI:1639150741
Name:WRIGHT, WAYNE CAMERON (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:CAMERON
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 1524
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-1524
Mailing Address - Country:US
Mailing Address - Phone:800-841-4236
Mailing Address - Fax:
Practice Address - Street 1:2501 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1735
Practice Address - Country:US
Practice Address - Phone:229-333-9729
Practice Address - Fax:229-333-0832
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0560012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA636633899BMedicaid
GA636633899BMedicaid
GAP00230689Medicare PIN
GA30BDMBQMedicare PIN