Provider Demographics
NPI:1770183758
Name:WILSON, WRIGHT CHARLES
Entity Type:Individual
Prefix:
First Name:WRIGHT
Middle Name:CHARLES
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 GREENE GABLES
Mailing Address - Street 2:
Mailing Address - City:RIDGELEY
Mailing Address - State:WV
Mailing Address - Zip Code:26753
Mailing Address - Country:US
Mailing Address - Phone:304-726-7178
Mailing Address - Fax:
Practice Address - Street 1:2013 GREENE GABLES
Practice Address - Street 2:
Practice Address - City:RIDGELEY
Practice Address - State:WV
Practice Address - Zip Code:26753
Practice Address - Country:US
Practice Address - Phone:304-726-7178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant