Provider Demographics
NPI:1912940982
Name:WRIGHT, JEFFREY WARREN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WARREN
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2150 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8052
Practice Address - Country:US
Practice Address - Phone:910-662-9480
Practice Address - Fax:910-662-9490
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29517207VM0101X, 207VM0101X
TXH3204207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1263AOtherBCBS
NC891263AMedicaid
NC1912940982Medicaid
NC1263AOtherBCBS
NCNCF871AMedicare PIN