Provider Demographics
NPI:1316185382
Name:COLQUITT PATHOLOGY PC
Entity Type:Organization
Organization Name:COLQUITT PATHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-985-5675
Mailing Address - Street 1:304 SUNSET CIR STE C
Mailing Address - Street 2:P O BOX 2047
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776-2047
Mailing Address - Country:US
Mailing Address - Phone:229-985-5675
Mailing Address - Fax:229-985-5675
Practice Address - Street 1:304 SUNSET CIR STE C
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6930
Practice Address - Country:US
Practice Address - Phone:229-985-5675
Practice Address - Fax:229-985-5675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046462207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty