Colquitt Regional Dermatology, LLC

NPI #1649683897 in Moultrie, Georgia

Provider Information

NPI Number: 1649683897
Entity Type: Organization
Organization Name: Colquitt Regional Dermatology, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: COLQUITT REGIONAL MEDICAL, INC
Primary Specialty: Dermatology
Enumeration Date: Jun 5, 2014
Last Updated: Jul 21, 2022

Practice Location

Address: 760 26TH AVE SE
City: Moultrie
State: Georgia
ZIP Code: 31768-6799
Phone: (229) 502-9710

Authorized Official

Name: AMANDA L ROBERTS
Title: PROVIDER ENROLLMENT COORDINATOR
Phone: (229) 891-9131

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dermatology	207N00000X	Primary

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