Our Lady Of The Roses Primary Care | |
808 21st St Columbus GA 31904-8817 | |
(706) 221-7232 | |
(706) 221-7246 |
Full Name | Our Lady Of The Roses Primary Care |
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Speciality | Nurse Practitioner |
Location | 808 21st St, Columbus, Georgia |
Authorized Official Name and Position | Gerald W. Wieczorek (REGISTERING AGENT) |
Authorized Official Contact | 7063274880 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Our Lady Of The Roses Primary Care Po Box 1957 Fortson GA 31808-1957 Ph: (706) 327-4880 | Our Lady Of The Roses Primary Care 808 21st St Columbus GA 31904-8817 Ph: (706) 221-7232 |
NPI Number | 1801119375 |
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Provider Enumeration Date | 03/11/2010 |
Last Update Date | 02/25/2014 |
Identifier | Type | State | Issuer |
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1801119375 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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208D00000X | General Practice | (* (Not Available)) | Secondary |
363L00000X | Nurse Practitioner | (* (Not Available)) | Primary |
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