Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN011769 | GA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 058033 | GA |
NPI | 1265527840 |
---|---|
Provider Name | Dr. Michael Mcbrearty Wright |
First Address | Macon, GA 31201-8423 |
Second Address | Macon, GA 31201-8423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |