Provider Demographics
NPI:1467825281
Name:J DEWAYNE COLQUITT MD LLC
Entity Type:Organization
Organization Name:J DEWAYNE COLQUITT MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:COLQUITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-735-0208
Mailing Address - Street 1:1173 CITADEL DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3815
Mailing Address - Country:US
Mailing Address - Phone:404-355-9255
Mailing Address - Fax:404-355-5822
Practice Address - Street 1:35 COLLIER RD NW STE 675
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1612
Practice Address - Country:US
Practice Address - Phone:404-355-9255
Practice Address - Fax:404-355-5822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty