Provider Demographics
NPI:1184344558
Name:WRIGHT, ROBERT RICHARD III
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:RICHARD
Last Name:WRIGHT
Suffix:III
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 1:690 GREAT OAKS RD
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:TN
Mailing Address - Zip Code:38028-3638
Mailing Address - Country:US
Mailing Address - Phone:901-461-3502
Mailing Address - Fax:
Practice Address - Street 1:690 GREAT OAKS RD
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:TN
Practice Address - Zip Code:38028-3638
Practice Address - Country:US
Practice Address - Phone:901-461-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN064404130172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver