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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