Basic Information
| Provider Information | |||||||||
| NPI: | 1902211642 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLQUITT REGIONAL EMERGENCY PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3697 | ||||||||
| Address2: | 3131 S. MAIN ST | ||||||||
| City: | MOULTRIE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317763697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005797777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3131 S MAIN ST | ||||||||
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| City: | MOULTRIE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317686925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293364621 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2014 | ||||||||
| LastUpdateDate: | 06/20/2014 | ||||||||
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| AuthorizedOfficialLastName: | PUROHIT | ||||||||
| AuthorizedOfficialFirstName: | SHAMB | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2295029703 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.