Healthcare Provider Details

I. General information

NPI: 1912099094
Provider Name (Legal Business Name): COLQUITT REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 SOUTH MAIN ST
MOULTRIE GA
31768-6925
US

IV. Provider business mailing address

3131 S MAIN ST
MOULTRIE GA
31768-6925
US

V. Phone/Fax

Practice location:
  • Phone: 229-985-3420
  • Fax:
Mailing address:
  • Phone: 229-985-3420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number035-296
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number035-01
License Number StateGA

VIII. Authorized Official

Name: JAMES L MATNEY
Title or Position: CEO
Credential:
Phone: 229-985-3420