Provider Demographics
NPI:1699710640
Name:WRIGHT-JONES, TENIESHA NICOLE (DO)
Entity type:Individual
Prefix:
First Name:TENIESHA
Middle Name:NICOLE
Last Name:WRIGHT-JONES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TENIESHA
Other - Middle Name:NICHOLE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:43750 GARFIELD RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1135
Mailing Address - Country:US
Mailing Address - Phone:877-996-9975
Mailing Address - Fax:586-228-4533
Practice Address - Street 1:22250 PROVIDENCE DR STE 500
Practice Address - Street 2:DEIGHTON FAMILY PRACTICE
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-6213
Practice Address - Country:US
Practice Address - Phone:248-849-3441
Practice Address - Fax:248-849-5389
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4914353/11Medicaid
080F3342800OtherBCBSM
MI700E012740OtherBCBS GROUP NUMBER
080F3342800OtherBCBSM
I55786Medicare UPIN
MI4914353/11Medicaid