Provider Demographics
NPI:1710742184
Name:WRIGHT, PHILOMENA EJEBHEN (FNP)
Entity Type:Individual
Prefix:
First Name:PHILOMENA
Middle Name:EJEBHEN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:FNP
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 43686
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30336-0686
Mailing Address - Country:US
Mailing Address - Phone:678-612-2395
Mailing Address - Fax:
Practice Address - Street 1:3991 PITTMAN RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-1456
Practice Address - Country:US
Practice Address - Phone:678-612-2395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN187858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily