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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