Provider Demographics
NPI:1841776333
Name:WRIGHT, DALLAS ANNE KNOX (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DALLAS
Middle Name:ANNE KNOX
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:DALLAS
Other - Middle Name:ANNE
Other - Last Name:KNOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1835 SAVOY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1071
Mailing Address - Country:US
Mailing Address - Phone:706-253-3100
Mailing Address - Fax:706-253-3101
Practice Address - Street 1:134 MOUNTAINSIDE VILLAGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-8694
Practice Address - Country:US
Practice Address - Phone:706-253-3100
Practice Address - Fax:706-253-3101
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008925363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG07116BOtherMEDICARE
GA003211324CMedicaid
GA003211324DMedicaid