Provider Demographics
NPI:1730495128
Name:MOULTRIE ORTHOPEDIC CLINIC, P.C.
Entity Type:Organization
Organization Name:MOULTRIE ORTHOPEDIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:D.
Authorized Official - Middle Name:QUILLIAN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:229-985-6377
Mailing Address - Street 1:316 SUNSET CIR
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6924
Mailing Address - Country:US
Mailing Address - Phone:229-985-6377
Mailing Address - Fax:229-890-9459
Practice Address - Street 1:316 SUNSET CIR
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6924
Practice Address - Country:US
Practice Address - Phone:229-985-6377
Practice Address - Fax:229-890-9459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOULTRIE ORTHOPEDICI CLINIC, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty