Provider Demographics
NPI:1336665371
Name:COLQUITT REGIONAL INFECTIOUS DISEASE LLC
Entity Type:Organization
Organization Name:COLQUITT REGIONAL INFECTIOUS DISEASE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:STRANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-890-3531
Mailing Address - Street 1:PO BOX 2438
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776-2438
Mailing Address - Country:US
Mailing Address - Phone:229-891-9009
Mailing Address - Fax:
Practice Address - Street 1:6 HOSPITAL PARK
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6700
Practice Address - Country:US
Practice Address - Phone:229-891-9009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty