Organization
COLQUITT REGIONAL DERMATOLOGY, LLC
Active
Organization
COLQUITT REGIONAL DERMATOLOGY, LLC
Active
Parent organization
COLQUITT REGIONAL MEDICAL, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLQUITT REGIONAL MEDICAL, INC
Authorized official
AMANDA L ROBERTS (PROVIDER ENROLLMENT COORDINATOR)
(229) 891-9131
Entity
Organization
Contact information
Practice address
760 26TH AVE SE, MOULTRIE, GA 31768-6799
(229) 502-9710
Mailing address
760 26TH AVE SE, MOULTRIE, GA 31768-6799
(229) 502-9710
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
06/05/2014
Last updated
07/21/2022
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