Provider Demographics
NPI:1265602940
Name:COLQUITT COMPLETE CARE LLC
Entity type:Organization
Organization Name:COLQUITT COMPLETE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:SWOFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-758-3002
Mailing Address - Street 1:103 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-3526
Mailing Address - Country:US
Mailing Address - Phone:229-758-3002
Mailing Address - Fax:229-758-9415
Practice Address - Street 1:103 W PINE ST
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-3526
Practice Address - Country:US
Practice Address - Phone:229-758-3002
Practice Address - Fax:229-758-9415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046262207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000815515CMedicaid
GA000815515CMedicaid
GA08BBTMHMedicare PIN