Provider Demographics
NPI:1184609729
Name:WRIGHT, CHARLES CLIFFORD JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CLIFFORD
Last Name:WRIGHT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:855-963-2100
Mailing Address - Fax:
Practice Address - Street 1:1 MERCY LN STE 200A
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6457
Practice Address - Country:US
Practice Address - Phone:501-525-4555
Practice Address - Fax:501-525-4685
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5463208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103017001Medicaid
AR103017001Medicaid
AR55843Medicare PIN
ARD83903Medicare UPIN
AR55843Medicare ID - Type Unspecified
AR13264000000OtherQUALCHOICE OF ARKANSAS
AR340013342OtherRRMCR
ARAW8014540OtherDEA NUMBER
AR55843OtherARK. BLUE CROSS BLUE SHIE
AR50172-340013342OtherRAILROAD MEDICARE