Healthcare Provider Details

I. General information

NPI: 1669937264
Provider Name (Legal Business Name): HOSPITAL AUTHORITY OF COLQUITT COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 HOSPITAL PARK
MOULTRIE GA
31768-6772
US

IV. Provider business mailing address

PO BOX 40 ATTN: STERLING GROUP PHARMACY
MOULTRIE GA
31776-0040
US

V. Phone/Fax

Practice location:
  • Phone: 229-891-9013
  • Fax: 229-891-9005
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JESSICA S JORDAN
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 229-985-3420