Provider Demographics
NPI:1477666089
Name:WRIGHT, JANNA S (SLP)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:S
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:S
Other - Last Name:GRIFFIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:2735 MIKELL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:GA
Mailing Address - Zip Code:31557-2009
Mailing Address - Country:US
Mailing Address - Phone:912-647-2170
Mailing Address - Fax:
Practice Address - Street 1:1415 ALICE ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4528
Practice Address - Country:US
Practice Address - Phone:912-283-0777
Practice Address - Fax:912-283-7757
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA251849142DMedicaid