Provider Demographics
NPI:1396515441
Name:WRIGHT, AMBER NICOLE (CSFA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 COCHISE CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-4238
Mailing Address - Country:US
Mailing Address - Phone:470-829-4759
Mailing Address - Fax:
Practice Address - Street 1:28 WHITE OAK DR SE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-2960
Practice Address - Country:US
Practice Address - Phone:267-776-5728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208540246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant