Provider Demographics
NPI:1245268176
Name:WRIGHT, JEAN A (MD, MBA)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-350-8016
Mailing Address - Fax:912-350-7221
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-8016
Practice Address - Fax:912-350-7221
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0226692080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10065828OtherAMERIGROUP
GA349842OtherWELLCARE
SCQ22669Medicaid
GA000266626HMedicaid
GA349842OtherWELLCARE
SCQ22669Medicaid