Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP003120 | VA |
NPI | 1184875429 |
---|---|
Provider Name | Mr. Gregory Carson Wright |
First Address | Fredericksburg, VA 22401-3701 |
Second Address | Fredericksburg, VA 22401-3701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2008 |
Last Update Date | 06/10/2008 |