Organization Name: | COLQUITT REGIONAL MEDICAL CENTER |
NPI Number: | 1316154834 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES L MATNEY (PRESIDENT) |
Mailing Address: | 2516 5th Ave Se Moultrie |
State: | GA US |
Postal Code: | 317886207 |
Phone Number: | 2299853420 |
Fax Number: | |
NPI Enumeration Date: | 05/16/2007 |
NPI Last Update Date: | 04/25/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251G00000X |
License Number: | 035069 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Hospice Care, Community Based |
Taxonomy Specialization: | |
Taxonomy Definition: |