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General NPI Number Information
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NPI Number | 1215153770
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Entity Type | Organization
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Legal Business Name | GWENDOLYN WILKES RAINBOW CENTER
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 2201 BUENA VISTA RD
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City | COLUMBUS
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State | GA
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Zip | 31906-3121
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Country | US
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Telephone | 706-320-9012
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Fax | 706-320-9021
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Provider Business Mailing Address
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Address Line | 2201 BUENA VISTA RD
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City | COLUMBUS
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State | GA
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Zip | 31906-3121
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Country | US
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Telephone | 706-320-9012
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Fax | 706-320-9021
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Authorized Official
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Title or Position | COORDINATOR
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Name | DR. GLORIA A RODGERS
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Credential | DO
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Telephone | 706-320-9012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State | GA
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