Healthcare Provider Details

I. General information

NPI: 1841707668
Provider Name (Legal Business Name): GUIDING LIGHT HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 HOSPITAL DR
WARNER ROBINS GA
31088-4204
US

IV. Provider business mailing address

124 HOSPITAL DR
WARNER ROBINS GA
31088-4204
US

V. Phone/Fax

Practice location:
  • Phone: 478-449-8800
  • Fax: 478-225-6504
Mailing address:
  • Phone: 478-449-8800
  • Fax: 478-225-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DONALD SHORTER
Title or Position: CEO
Credential:
Phone: 478-449-8800