NPI age
10 years
Enumerated 2015-10-07
● Active Type 2 · Organization
Our Lady Of The Roses Primary Care
Our Lady Of The Roses Primary Care is 1 of 3 clinic/center organizations in Georgia.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Wieczorek
Business Manager
Last NPPES update
2015-10-07
Source: monthly bulk 2026-05
How this organization compares
Across 3 active clinic/center providers in Georgia.
NPI age
10 years
↓ 3 yr below median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2015 → 2026
2015-10Enumerated in NPPES
2015
2026
Where they practice
Primary practice location
808 21st St
Columbus, GA 319048817
Mailing address
Po Box 1957
Fortson, GA 318081957
Authorized official
Gerald William Wieczorek
Business Manager
📞 7063274880
Individual providers at this organization
2 individual providers on file at this primary practice address.
- Anneliese Chai, PA-C Physician Assistant NPI 1760445753
- Susan Wieczorek, NP-C, CWOCN Nurse Practitioner NPI 1013087386
Specialties
-
Clinic/Center PrimaryDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 000901106D | |
| 05 (AL) | 126693 |
Practice context
Multi-provider organization. 2 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.