Provider Demographics
NPI:1396729752
Name:WRIGHT, SUSAN JOY (FAMILY NURSE PRACTIT)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:JOY
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:MAUREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1204 ASHBOROUGH TER SE
Mailing Address - Street 2:UNIT E
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6935
Mailing Address - Country:US
Mailing Address - Phone:678-290-3312
Mailing Address - Fax:
Practice Address - Street 1:865 N HIGHLAND AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-4565
Practice Address - Country:US
Practice Address - Phone:404-733-6089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN068035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBJXVMedicare UPIN
S81804Medicare UPIN