Provider Demographics
NPI:1639270440
Name:WRIGHT, ARCHIE W (DO)
Entity Type:Individual
Prefix:DR
First Name:ARCHIE
Middle Name:W
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-668-1668
Mailing Address - Fax:731-668-5801
Practice Address - Street 1:322 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305
Practice Address - Country:US
Practice Address - Phone:731-668-1668
Practice Address - Fax:731-668-5801
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17568207RH0003X
TNDO0000001848207RH0003X
TN01848207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000109Medicaid
I25311Medicare UPIN
30001091Medicare PIN