Provider Demographics
NPI:1528615713
Name:WRIGHT, JENNIFER RUTH (MS RD/LDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RUTH
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MS RD/LDN
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 459
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:GA
Mailing Address - Zip Code:30628-0459
Mailing Address - Country:US
Mailing Address - Phone:706-788-3234
Mailing Address - Fax:706-788-2936
Practice Address - Street 1:11 CHARLIE MORRIS RD
Practice Address - Street 2:
Practice Address - City:COLBERT
Practice Address - State:GA
Practice Address - Zip Code:30628-2445
Practice Address - Country:US
Practice Address - Phone:706-788-2127
Practice Address - Fax:706-788-2815
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005308133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered