MEDICARE: WHOLE PATIENT HEALTHCARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1205583457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE PATIENT HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	1338 13TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-2303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1338 13TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-2303
Country	:	US
Telephone Number	:	706-641-2080
Fax Number	:

Authorized Official
Title or Position	:	MANAGE
Name	:	JADA RHYMES
Credential	:	MD
Telephone Number	:	478-396-7120

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	03/08/2022

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