Provider Demographics
NPI:1801080700
Name:WRIGHT, JESSIE GODWIN (MS,RD,LD,CSR)
Entity type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:GODWIN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MS,RD,LD,CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5532
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-0532
Mailing Address - Country:US
Mailing Address - Phone:706-563-5783
Mailing Address - Fax:706-561-5838
Practice Address - Street 1:3025 UNIVERSITY AVE
Practice Address - Street 2:SUITE C-1
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-2101
Practice Address - Country:US
Practice Address - Phone:706-563-5783
Practice Address - Fax:706-561-5838
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA95133V00000X
AL514133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered