Provider Demographics
NPI:1972134526
Name:WRIGHT, MIRANDA RAGAN (DR)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:RAGAN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 APPLECROSS CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-7440
Mailing Address - Country:US
Mailing Address - Phone:478-747-6814
Mailing Address - Fax:
Practice Address - Street 1:4650 FORSYTH RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4456
Practice Address - Country:US
Practice Address - Phone:478-747-7413
Practice Address - Fax:478-757-0971
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0199561835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist