# OUR LADY OF THE ROSES PRIMARY CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801119375
- **Authorized official:** MR. GERALD W. WIECZOREK (REGISTERING AGENT)
- **Authorized official phone:** (706) 327-4880

## Contact information

- **Practice address:** 808 21ST ST, COLUMBUS, GA 31904-8817
- **Practice address phone:** (706) 221-7232
- **Practice address fax:** (706) 221-7246
- **Mailing address:** PO BOX 1957, FORTSON, GA 31808-1957
- **Mailing address phone:** (706) 327-4880
- **Mailing address fax:** (706) 327-4880

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | — |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/11/2010
- **Last updated:** 02/25/2014