MEDICARE: JENNIFER WRIGHT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	7109	GA

General Provider Information

NPI Number	:	1679992341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER WRIGHT PA-C

Provider Business Mailing Address
First Line	:	3225 CUMBERLAND BLVD SE STE 510
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-6396
Country	:	US
Telephone Number	:	404-806-6330
Fax Number	:	404-806-6352

Provider Business Practice Location Address
First Line	:	3225 CUMBERLAND BLVD SE STE 510
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-6396
Country	:	US
Telephone Number	:	404-806-6330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	10/03/2024

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