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Organization
COLQUITT REGIONAL PEDIATRICS, LLC
Active
Organization
COLQUITT REGIONAL PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE ROMANOWSKI (DIRECTOR)
(229) 891-9559
Entity
Organization
Contact information
Practice address
1 SWEET BAY CT, MOULTRIE, GA 31768-6756
(229) 985-5437
(229) 985-0131
Mailing address
PO BOX 1120, MOULTRIE, GA 31776-1120
(229) 985-5437
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003170656A
—
GA
05
—
003170656B
—
GA
01
—
10270G0891
MEDICARE GROUP PTAN
GA
Enumeration date
10/28/2015
Last updated
05/08/2018
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