Healthcare Provider Details

I. General information

NPI: 1063610905
Provider Name (Legal Business Name): SUZANNE JEFFERS WAYBRIGHT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZANNE MICHELE JEFFERS RN

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 WINDSOR SPRING RD
AUGUSTA GA
30906-4668
US

IV. Provider business mailing address

4153 QUINN DR
EVANS GA
30809-4817
US

V. Phone/Fax

Practice location:
  • Phone: 706-790-2514
  • Fax:
Mailing address:
  • Phone: 706-854-0817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN166823
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: