COLQUITT REGIONAL PATHOLOGY, LLC (NPI# 1942865480) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942865480 |
| Entity Type | Organization |
| Organization Name | COLQUITT REGIONAL PATHOLOGY, LLC |
| Practice Address |
3131 S Main St Moultrie GA 31768-6925 |
| Mailing Address |
Po Box 2862 Moultrie GA 31776-2862 |
| Practice Telephone | 2299853420 |
| Mailing Telephone | 2299855675 |
| Mailing Fax Number | 2299855675 |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2019-09-20 |
| Authorized Official Name | NANCY FITCH (PRACTICE MANAGER) |
| Authorized Official Telephone | 2299855675 |
| Is Organization Subpart | Y |
| Parent Organization Name | COLQUITT REGIONAL MEDICAL INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 003220270A | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 304 Sunset Cir Ste C, Moultrie, GA 317686930 | 2299855675 | 2299855675 |
| Street Address |
3131 S MAIN ST |
| City | MOULTRIE |
| State | GA |
| Zip Code | 31768-6925 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255323564 | Dale Mcgregor | Emergency Medicine | 3131 S Main St, Moultrie, GA 31768-6925 | 2005-08-22 |
| 1144861485 | Rebecca Lee Hayes | Nurse Practitioner | 3131 S Main St, Moultrie, GA 31768-6925 | 2019-10-07 |
| 1669937264 | Colquitt County Hospital Authority | Pharmacy | 3131 S Main St, Moultrie, GA 31768-6925 | 2019-02-07 |
| 1407331143 | Christopher Neil Medders | Nurse Practitioner | 3131 S Main St, Moultrie, GA 31768-6925 | 2018-09-28 |
| 1255832671 | Alexa Smith | Occupational Therapist | 3131 S Main St, Moultrie, GA 31768-6925 | 2018-02-21 |
| 1346757481 | Jeffery W Roberts | Nurse Anesthetist, Certified Registered | 3131 S Main St, Moultrie, GA 31768-6925 | 2018-01-10 |
| 1720593239 | Colquitt Regional Medical Center | Ambulance | 3131 S Main St, Moultrie, GA 31768-6925 | 2017-12-06 |
| 1689188906 | Mary Ann Waller | Speech-Language Pathologist | 3131 S Main St, Moultrie, GA 31768-6925 | 2017-11-22 |
| 1063923688 | Radiology Associates of Moultrie LLC | Radiology | 3131 S Main St, Moultrie, GA 31768-6925 | 2017-10-23 |
| 1629590898 | Amanda Jackson | Nurse Anesthetist, Certified Registered | 3131 S Main St, Moultrie, GA 31768-6925 | 2017-07-10 |
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| 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 |
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| Taxonomy Code | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700225760 | Robert John Nelms Jr. | Pathology | 107 Fairway Dr, Moultrie, GA 31768-6823 | 2013-06-22 |
| 1316185382 | Colquitt Pathology PC | Pathology | 304 Sunset Cir Ste C, Moultrie, GA 31768-6930 | 2009-01-29 |
| 1750709325 | Cory Porteus | Pathology | 3131 S Main St, Moultrie, GA 31768-6925 | 2014-04-01 |
| 1063520179 | Anthony M Moser | Pathology | 3131 S Main St, Moultrie, GA 31768-6925 | 2006-08-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255957148 | Thomas E Cotter | Pathology | 1120 15th St # Bf-103b, Augusta, GA 30912-0004 | 2020-06-17 |
| 1386269835 | Pramila Pallikkappara Moideen | Pathology | Augusta University Medical Center Room Bf-103-b, Augusta, GA 30912-0001 | 2020-06-10 |
| 1558921973 | Anna Nielsen Walker | Pathology | Mercer University School of Medicine Dept of Pathology, Macon, GA 31207-0001 | 2019-06-18 |
| 1437678950 | Thomas William Stewart Jr. | Pathology | 3138 Marthasville Court, Gainesville, GA 30506 | 2017-09-15 |
| 1750725099 | Charles Jacob Stoudenmire | Pathology | 507 W 3rd Ave Ste 7, Albany, GA 31701 | 2013-04-17 |
| 1902143589 | Lindsey Oreita Lowder | Pathology | 1968 Peachtree Rd Nw Bldg 774th, Atlanta, GA 30309-1281 | 2013-01-15 |
| 1184918476 | Stephen Alan Dayan | Pathology | 830 Johns Landing Way, Lawrenceville, GA 30045-6369 | 2011-06-03 |
| 1760793673 | Andrew Erling Johnsen | Pathology | 3248 Avalon Pkwy, Conyers, GA 30013-6320 | 2010-06-24 |
| 1497066518 | Charles Omar Wilson Jr. | Pathology | 175 Samaritan Way, Jasper, GA 30143 | 2010-06-23 |
| 1073840864 | Jyotsna K Dhar | Pathology | 1331 Marietta Country Club Dr Nw, Kennesaw, GA 30152-4733 | 2009-11-16 |
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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.