Provider Demographics
NPI:1023109147
Name:WRIGHT, ERIC R (PAC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:R
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 SW CENTER ST
Mailing Address - Street 2:P.O. BOX 187
Mailing Address - City:FAISON
Mailing Address - State:NC
Mailing Address - Zip Code:28341-8820
Mailing Address - Country:US
Mailing Address - Phone:910-267-0421
Mailing Address - Fax:910-267-0441
Practice Address - Street 1:360 E CHARITY RD
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:NC
Practice Address - Zip Code:28458-8303
Practice Address - Country:US
Practice Address - Phone:910-289-3086
Practice Address - Fax:910-267-8992
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004627363A00000X
NC0010-02694363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8380115Medicaid
NCNC8641AOtherMEDICARE PTAN
R81235Medicare UPIN