Provider Demographics
NPI:1962869180
Name:WRIGHT, MONTAGO MAURICE
Entity type:Individual
Prefix:
First Name:MONTAGO
Middle Name:MAURICE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201B W BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2536
Mailing Address - Country:US
Mailing Address - Phone:864-509-0435
Mailing Address - Fax:864-509-0250
Practice Address - Street 1:511 PALMETTO DR
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-6128
Practice Address - Country:US
Practice Address - Phone:864-509-0435
Practice Address - Fax:864-509-0250
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide