Healthcare Provider Details

I. General information

NPI: 1336739556
Provider Name (Legal Business Name): ANNA GOODBREAD WRIGHT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 WALTON WAY
AUGUSTA GA
30909-3827
US

IV. Provider business mailing address

719 RAVENEL RD
AUGUSTA GA
30909-1835
US

V. Phone/Fax

Practice location:
  • Phone: 706-842-3279
  • Fax:
Mailing address:
  • Phone: 706-373-7993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: