Our Lady of the Roses Primary Care

NPI #1801119375 in Columbus, Georgia

Provider Information

NPI Number: 1801119375
Entity Type: Organization
Organization Name: Our Lady of the Roses Primary Care
Primary Specialty: Nurse Practitioner
Enumeration Date: Mar 11, 2010
Last Updated: Feb 25, 2014

Practice Location

Address: 808 21ST ST
City: Columbus
State: Georgia
ZIP Code: 31904-8817
Phone: (706) 221-7232

Authorized Official

Name: MR. GERALD W. WIECZOREK
Title: REGISTERING AGENT
Phone: (706) 327-4880

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
General Practice	208D00000X
Nurse Practitioner	363L00000X	Primary

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