| Jessica Wright, | |
|
605 Smith Ave, Cedartown, GA 30125-2345 | |
| (678) 988-4562 | |
| Not Available |
| Full Name | Jessica Wright |
|---|---|
| Gender | Female |
| Speciality | Counselor - Professional |
| Location | 605 Smith Ave, Cedartown, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336896562 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | LPC014847 (Georgia) | Primary |
| Entity Name | Grow Healthcare Group Pa |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1245845932 PECOS PAC ID: 3476961368 Enrollment ID: O20220315000829 |
| Entity Name | Vitae Health Medical Georgia Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1184320574 PECOS PAC ID: 4183079577 Enrollment ID: O20231004002138 |
| Mailing Address | Practice Location Address |
|---|---|
| Jessica Wright, 605 Smith Ave, Cedartown, GA 30125-2345 Ph: (678) 988-4562 | Jessica Wright, 605 Smith Ave, Cedartown, GA 30125-2345 Ph: (678) 988-4562 |
Mrs. Cathy Puckett, Counselor Medicare: Not Enrolled in Medicare Practice Location: 180 Water Oak Dr, Cedartown, GA 30125 Phone: 770-748-2225 Fax: 770-749-0939 | |
Toni-marie Bryan, LAPC, MA Counselor Medicare: Not Enrolled in Medicare Practice Location: 740 Fletcher St, Cedartown, GA 30125 Phone: 770-748-1500 | |
Mrs. Deanna Ruth Dennis, LPC Counselor Medicare: Medicare Enrolled Practice Location: 180 Wateroak Drive, Cedartown, GA 30125 Phone: 706-748-2225 Fax: 706-749-0939 | |
Patti Williams, Counselor Medicare: Not Enrolled in Medicare Practice Location: 180 Water Oak Dr, Cedartown, GA 30125 Phone: 770-748-2225 Fax: 770-749-4418 | |
Chase Tarleton, LMSW Counselor Medicare: Not Enrolled in Medicare Practice Location: 740 Fletcher St, Cedartown, GA 30125 Phone: 770-748-1500 | |
Jessica Wingo Leatherwood, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 62 Coaling Rd, Cedartown, GA 30125 Phone: 770-842-7172 | |
Mr. Gerald Shepard, CACI Counselor Medicare: Not Enrolled in Medicare Practice Location: 180 Water Oak Dr, Cedartown, GA 30125 Phone: 770-748-2225 |