1336291079 NPI number — MR. CHERYL LYNN WRIGHT-RIDDELL M.A.

Table of content: MR. CHERYL LYNN WRIGHT-RIDDELL M.A. (NPI 1336291079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336291079 NPI number — MR. CHERYL LYNN WRIGHT-RIDDELL M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT-RIDDELL
Provider First Name:
CHERYL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WRIGHT-RIDDELL
Provider Other First Name:
CHER
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336291079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 MOUNTAIN CREEK TRCE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30328-3523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-250-1267
Provider Business Mailing Address Fax Number:
404-255-0268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4501 CIRCLE 75 PKWY SE
Provider Second Line Business Practice Location Address:
SUITE 5220E
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30339-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-291-1998
Provider Business Practice Location Address Fax Number:
404-255-0268
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  001906 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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