COLQUITT REGIONAL MEDICAL CENTER (NPI# 1881758753) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881758753 |
| Entity Type | Organization |
| Organization Name | COLQUITT REGIONAL MEDICAL CENTER |
| Other Organization Name | COLQUITT REGIONAL PRIMARY CARE CLINIC |
| Practice Address |
6 Hospital Park Moultrie GA 31768-6700 |
| Mailing Address |
Po Box 3037 Moultrie GA 31776-3037 |
| Practice Telephone | 2299853320 |
| Practice Fax Number | 2298901282 |
| Mailing Telephone | 2299853320 |
| Mailing Fax Number | 2298901282 |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2009-07-17 |
| Authorized Official Name | C. GARY LODGE (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 2299853320 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | COLQUITT REGIONAL MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
14029 | GA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00002021E | 05 | |
| GA | 00002021D | 05 |
| Other Name | Type Code |
|---|---|
| Colquitt Regional Primary Care Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912099094 | Colquitt Regional Medical Center | Ambulance | 3131 South Main St, Moultrie, GA 31768-6925 | 2006-09-28 |
| 1720593239 | Colquitt Regional Medical Center | Ambulance | 3131 S Main St, Moultrie, GA 31768-6925 | 2017-12-06 |
| 1962850396 | Colquitt Regional Medical Center | Family Medicine | 1 Magnolia Ct, Moultrie, GA 31768 | 2016-05-26 |
| 1720359326 | Colquitt Regional Medical Center | Medicare Defined Swing Bed Unit | 3131 S Main St, Moultrie, GA 31768-6925 | 2012-01-13 |
| 1316154834 | Colquitt Regional Medical Center | Hospice Care, Community Based | 2516 5th Ave Se, Moultrie, GA 31788-6207 | 2007-05-16 |
| 1124155965 | Colquitt Regional Medical Center | Clinic/Center | 3131 S Main St, Moultrie, GA 31768-6925 | 2007-02-28 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | COLQUITT REGIONAL MEDICAL CENTER | 3131 S Main St, Moultrie, GA 31768-6925 |
| Street Address |
6 HOSPITAL PARK |
| City | MOULTRIE |
| State | GA |
| Zip Code | 31768-6700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366521205 | Charles Gary Lodge | Family Medicine | 6 Hospital Park, Moultrie, GA 31768-6700 | 2006-11-02 |
| 1336665371 | Colquitt Regional Infectious Disease LLC | Internal Medicine | 6 Hospital Park, Moultrie, GA 31768-6700 | 2017-08-22 |
| 1982124285 | Mary Catherine Seabrook Duskin | Family Medicine | 6 Hospital Park, Moultrie, GA 31768-6700 | 2017-06-27 |
| 1629485032 | Colquitt Regional Internal Medicine | Internal Medicine | 6 Hospital Park, Moultrie, GA 31768-6700 | 2014-07-17 |
| 1457791857 | Sedrick Bradley | Internal Medicine | 6 Hospital Park, Moultrie, GA 31768 | 2013-06-28 |
| 1639359342 | Jeong Sok Seo | Internal Medicine | 6 Hospital Park, Moultrie, GA 31768-6700 | 2007-11-09 |
| 1841369949 | Billy Ray Price II | Family Medicine | 6 Hospital Park, Moultrie, GA 31768-6700 | 2006-11-06 |
| 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 | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437651924 | Amanda Mckenzie | Clinic/Center | Us Renal Care 657 Hemlock Street, Macon, GA 31206 | 2018-03-01 |
| 1518398049 | Norman Park Family Medicine Clinic | Clinic/Center | 139 East Broad Street, Norman Park, GA 31771 | 2013-12-10 |
| 1992147573 | Doerun Family Medicine Clinic | Clinic/Center | 128 West Broad Ave, Doerun, GA 31744 | 2013-07-23 |
| 1366784415 | Emanuel County Hospital Authority | Clinic/Center | 131a Victory Dr, Swainsboro, GA 30401-3234 | 2013-03-26 |
| 1306114004 | Lower Oconee Community Hospital, Inc | Clinic/Center | 421 W Robinson Dr, Mount Vernon, GA 30445-2935 | 2011-12-08 |
| 1013248962 | Southern Health Corp of Ellijay | Clinic/Center | 60 Old Highway 5 South, Ellijay, GA 30540-5436 | 2010-01-15 |
| 1427384353 | Union County Hospital Authority | Clinic/Center | 103 Church St Ste A, Hiawassee, GA 30546-3223 | 2009-10-28 |
| 1346574084 | Durall Capital Holdings, LLC | Clinic/Center | 59 Tipton Drive, Dahlonega, GA 30533 | 2009-09-29 |
| 1215260617 | Durall Capital Holdings, LLC | Clinic/Center | 35 Lumpkin Campground Road N, Dawsonville, GA 30534 | 2009-09-16 |
| 1376778001 | Phoebe Sumter Medical Center, Inc | Clinic/Center | 339 S Broad St, Ellaville, GA 31806-3304 | 2009-05-26 |
| 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.