Provider Demographics
NPI:1083326656
Name:ALBRIGHT, JESSICA L (RN BSN IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:ALBRIGHT
Suffix:
Gender:F
Credentials:RN BSN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-2145
Mailing Address - Country:US
Mailing Address - Phone:812-319-9600
Mailing Address - Fax:
Practice Address - Street 1:1111 GLYNCO PKWY STE 31
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-7930
Practice Address - Country:US
Practice Address - Phone:912-456-3605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN298395163WL0100X
GALC000235163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-47914OtherIBCLC
GALC000235OtherSTATE OF GEORGIA