Provider Demographics
NPI:1659081370
Name:WRIGHT, TAMMY ALISHA
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:ALISHA
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 GRAYSON HWY STE 8-125
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1245
Mailing Address - Country:US
Mailing Address - Phone:334-803-2875
Mailing Address - Fax:
Practice Address - Street 1:1471 BEECHWOOD CIR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8844
Practice Address - Country:US
Practice Address - Phone:334-803-2875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059023447172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver