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Organization
OUR LADY OF THE ROSES PRIMARY CARE
Active
Organization
OUR LADY OF THE ROSES PRIMARY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD W. WIECZOREK (REGISTERING AGENT)
(706) 327-4880
Entity
Organization
Contact information
Practice address
808 21ST ST, COLUMBUS, GA 31904-8817
(706) 221-7232
(706) 221-7246
Mailing address
PO BOX 1957, FORTSON, GA 31808-1957
(706) 327-4880
(706) 327-4880
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/11/2010
Last updated
02/25/2014
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