Provider Demographics
NPI:1629796040
Name:ABUNDANT GRACE AND BLESSINGS BY T
Entity Type:Organization
Organization Name:ABUNDANT GRACE AND BLESSINGS BY T
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMEIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-573-8349
Mailing Address - Street 1:100 LOCKWOOD CT APT 133
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-4917
Mailing Address - Country:US
Mailing Address - Phone:706-573-8349
Mailing Address - Fax:
Practice Address - Street 1:639 ANNETTE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-3903
Practice Address - Country:US
Practice Address - Phone:706-573-8349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty