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General NPI Number Information
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NPI Number | 1629796040
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Entity Type | Organization
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Legal Business Name | ABUNDANT GRACE AND BLESSINGS BY T
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 2201 BUENA VISTA RD STE B1
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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 | 706-577-1760
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 BUENA VISTA RD STE B1
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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 | 706-577-1760
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TAMEIKA BOGAN
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Credential |
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Telephone | 706-573-8349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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