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Individual

JACQUE WRIGHT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BSPP

Contact information

Practice address
1503 E MOORE ST, VALDOSTA, GA 31601-3364
(352) 870-9289
Mailing address
1503 E MOORE ST, VALDOSTA, GA 31601-3364
(352) 870-9289

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
058028919
GA

Other

Enumeration date
09/21/2016
Last updated
09/21/2016
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