| Organization Name: | COLQUITT REGIONAL PAIN CLINIC, LLC |
| NPI Number: | 1295192391 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WENDELL SIMS (CFO) |
| Mailing Address: | 3131 S Main St Moultrie |
| State: | GA US |
| Postal Code: | 317686925 |
| Phone Number: | 2299853420 |
| Fax Number: | |
| NPI Enumeration Date: | 01/20/2016 |
| NPI Last Update Date: | 01/20/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207LP2900X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Anesthesiology |
| Taxonomy Specialization: | Pain Medicine |
| Taxonomy Definition: | An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists. |