Provider Demographics
NPI:1407944887
Name:WRIGHT, GILL C (MD)
Entity type:Individual
Prefix:DR
First Name:GILL
Middle Name:C
Last Name:WRIGHT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-5482
Mailing Address - Country:US
Mailing Address - Phone:843-955-9724
Mailing Address - Fax:
Practice Address - Street 1:1931 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-5482
Practice Address - Country:US
Practice Address - Phone:843-955-9724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-225442083P0500X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSK21C641Medicare ID - Type Unspecified
E48225Medicare UPIN