Organization
COLQUITT REGIONAL ANESTHESIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY B RICKS (PROVIDER ENROLLMENT COORDINATOR)
(229) 891-9131
Entity
Organization
Contact information
Practice address
3131 S MAIN ST, MOULTRIE, GA 31768-6925
(229) 985-3420
(229) 891-9079
Mailing address
PO BOX 3305, MOULTRIE, GA 31776-3305
(229) 985-3420
(229) 891-9079
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
06/02/2008
Last updated
06/02/2008
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