Active NPI
Jerry Kimberly Wright, DDS
- Dentist
- Jefferson, GA
National Provider Identifier
1205956570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8563
- Practice address
- 92 North Public SQ
Jefferson, GA 30549-1084 - Phone
- (706) 367-2577
- Fax
- (706) 367-2573
- NPI assigned
- Mar 30, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8563 | GA | Primary |
Addresses
Primary practice location
92 North Public SQ
Jefferson, GA 30549-1084
Mailing address
92 North Public SQ
Jefferson, GA 30549-1084
Phone (706) 367-2577
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8563 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205956570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "92 NORTH PUBLIC SQ",
"city": "JEFFERSON",
"state": "GA",
"postal_code": "305491084",
"telephone_number": "706-367-2577",
"fax_number": "706-367-2573"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "92 NORTH PUBLIC SQ",
"city": "JEFFERSON",
"state": "GA",
"postal_code": "305491084",
"telephone_number": "706-367-2577",
"fax_number": "706-367-2573"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WRIGHT",
"first_name": "JERRY",
"middle_name": "KIMBERLY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "8563",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jefferson, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.