Healthcare Provider Details

I. General information

NPI: 1801080700
Provider Name (Legal Business Name): JESSIE GODWIN WRIGHT MS,RD,LD,CSR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 UNIVERSITY AVE SUITE C-1
COLUMBUS GA
31907-2101
US

IV. Provider business mailing address

PO BOX 5532
COLUMBUS GA
31906-0532
US

V. Phone/Fax

Practice location:
  • Phone: 706-563-5783
  • Fax: 706-561-5838
Mailing address:
  • Phone: 706-563-5783
  • Fax: 706-561-5838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number95
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number514
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: