Provider Demographics
NPI:1821382672
Name:COLQUITT REGIONAL OB/GYN, LLC
Entity Type:Organization
Organization Name:COLQUITT REGIONAL OB/GYN, LLC
Other - Org Name:MOULTRIE CENTER FOR WOMEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-891-9365
Mailing Address - Street 1:PO BOX 3233
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776-3233
Mailing Address - Country:US
Mailing Address - Phone:229-985-2198
Mailing Address - Fax:229-891-3250
Practice Address - Street 1:3 SWEET BAY CT
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768
Practice Address - Country:US
Practice Address - Phone:229-985-2198
Practice Address - Fax:229-891-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty