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General NPI Number Information
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NPI Number | 1154265171
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Entity Type | Organization
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Legal Business Name | GUARDIAN LIGHT
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Dates
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Enumeration Date | 04/18/2026
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Last Update Date | 04/18/2026
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Provider Practice Location Address
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Address Line | 547 E LEE ST
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City | DAWSON
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State | GA
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Zip | 39842-1555
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Country | US
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Telephone | 229-310-1438
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 41
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City | DAWSON
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State | GA
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Zip | 39842-0041
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Country | US
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Telephone | 229-310-1438
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | SHANIQUA POWELL
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Credential |
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Telephone | 229-338-0602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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