COLQUITT REGIONAL CARDIOLOGY, LLC (NPI# 1336570191) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336570191 |
| Entity Type | Organization |
| Organization Name | COLQUITT REGIONAL CARDIOLOGY, LLC |
| Practice Address |
115 31st Ave Se Moultrie GA 31768-6771 |
| Mailing Address |
Po Box 2317 Moultrie GA 31776-2317 |
| Practice Telephone | 2298905305 |
| Practice Fax Number | 2298905307 |
| Mailing Telephone | 2298905305 |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2019-07-18 |
| Authorized Official Name | AMANDA L ROBERTS (PROVIDER ENROLLMENT COORDINATOR) |
| Authorized Official Telephone | 2298919131 |
| Is Organization Subpart | Y |
| Parent Organization Name | COLQUITT REGIONAL MEDICAL, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| Street Address |
115 31ST AVE SE |
| City | MOULTRIE |
| State | GA |
| Zip Code | 31768-6771 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902801285 | James David Waller | Internal Medicine | 115 31st Ave Se, Moultrie, GA 31768-6771 | 2005-06-14 |
| 1174154421 | Southeastern Urogynecology and Pelvic Surgery LLC | Obstetrics & Gynecology | 115 31st Ave Se, Moultrie, GA 31768-6771 | 2020-01-27 |
| 1417405176 | Benjamin L Mcleod | Nurse Practitioner | 115 31st Ave Se, Moultrie, GA 31768-6771 | 2016-09-12 |
| 1316362973 | Julie Marie Posey | Nurse Practitioner | 115 31st Ave Se, Moultrie, GA 31768-6771 | 2014-02-19 |
| 1255694253 | Pallavi Luthra | Internal Medicine | 115 31st Ave Se, Moultrie, GA 31768 | 2012-06-25 |
| 1215209416 | Colquitt Regional Urology, LLC | Urology | 115 31st Ave Se, Moultrie, GA 31768-6771 | 2012-02-02 |
| 1376700807 | Lawrence Ukpong | Internal Medicine | 115 31st Ave Se, Moultrie, GA 31768-6771 | 2008-05-21 |
| 1275679110 | Ronald E Trescot Md PC | Obstetrics & Gynecology | 115 31st Ave Se, Moultrie, GA 31768 | 2007-01-29 |
| 1801880497 | Jacquelyn Elaine Roberts | Nurse Practitioner | 115 31st Ave Se, Moultrie, GA 31768-6771 | 2005-09-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356975452 | Zachary Schiffer | Specialist/Technologist | 3131 S Main Street, Moultrie, GA 31768 | 2020-02-27 |
| 1326697731 | Daisy Concierge Care | Nursing Care | 437 S. Morris Rd Lt 1, Moultrie, GA 31768 | 2019-09-09 |
| 1194208751 | Regina Mercer Ward | Nurse Practitioner | 1724 Villa Dr Sw, Moultrie, GA 31768 | 2018-09-10 |
| 1225473630 | Moultrie Orthodontics, P.C. | Clinic/Center | 12 Longleaf Office Park, Moultrie, GA 31768 | 2013-04-30 |
| 1497032239 | Freds Stores of Tennessee Inc | Pharmacy | 2601 South Main Street, Moultrie, GA 31768 | 2011-11-08 |
| 1821382672 | Colquitt Regional Ob/gyn, LLC | Obstetrics & Gynecology | 3 Sweet Bay Ct, Moultrie, GA 31768 | 2011-06-08 |
| 1568779809 | Shana Goodno | Nurse Practitioner | 207 31 St Ave Se, Moultrie, GA 31768 | 2010-09-08 |
| 1508177445 | Cherokee Rose Emergency Physicians | Emergency Medicine | 3131 South Main Street, Moultrie, GA 31768 | 2010-06-25 |
| 1023299963 | Hetal Patel | Counselor | 600 2nd St South East, Moultrie, GA 31768 | 2007-11-20 |
| 1720146756 | William C Byrd Inc | Assisted Living Facility | 498 5th Street Se, Moultrie, GA 31768 | 2006-12-04 |
| Find all providers in zip 31768 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710027800 | Cardiac Disease Consultants, LLC | Internal Medicine | 1 Sweet Bay Ct Ste B, Moultrie, GA 31768-6713 | 2007-02-07 |
| 1902801285 | James David Waller | Internal Medicine | 115 31st Ave Se, Moultrie, GA 31768-6771 | 2005-06-14 |
| 1255694253 | Pallavi Luthra | Internal Medicine | 115 31st Ave Se, Moultrie, GA 31768 | 2012-06-25 |
| 1376700807 | Lawrence Ukpong | Internal Medicine | 115 31st Ave Se, Moultrie, GA 31768-6771 | 2008-05-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013571033 | Norihiko Kamioka | Internal Medicine | 1364 Clifton Rd Ne Ste D422, Atlanta, GA 30322-1059 | 2019-04-24 |
| 1992229884 | Medical Software, LLC | Internal Medicine | 3855 Pleasant Hill Rd Ste 350, Duluth, GA 30096-8093 | 2017-08-01 |
| 1215399456 | Raymond Mai | Internal Medicine | 1120 15th St # 6518, Augusta, GA 30912-1436 | 2016-03-27 |
| 1043684954 | Columbus Cardiology Associates, PC | Internal Medicine | 905 N Jackson St, Ste B, Americus, GA 31719-3089 | 2015-11-17 |
| 1649693045 | Avantgarde Consultants, Inc. | Internal Medicine | 10945 State Bridge Rd Ste 401-708, Alpharetta, GA 30022-8164 | 2014-01-22 |
| 1194153973 | Epic Group 8 | Internal Medicine | 760 Old Roswell Rd, Suite 114, Roswell, GA 30076-2279 | 2013-10-14 |
| 1982940987 | Southeastern Cardiovascular Associates LLC | Internal Medicine | 1076 Bermuda Run, Statesboro, GA 30458-0858 | 2012-12-19 |
| 1265798763 | Sulay Pankaj Patel | Internal Medicine | 101 Woodruff Circle Wmb 1013, Atlanta, GA 30322 | 2012-04-09 |
| 1073879573 | Ozlem Bilen | Internal Medicine | Emory University Cardiovascular, 101 Woodruff Circle, Wmb 3004, Atlanta, GA 30322-0001 | 2012-04-09 |
| 1962779611 | Cardiac Consultants of Central Georgia | Internal Medicine | 2024 Watson Blvd Bldg 1, Warner Robins, GA 31093-3624 | 2011-11-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.