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General NPI Number Information
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NPI Number | 1265602940
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Entity Type | Organization
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Legal Business Name | COLQUITT COMPLETE CARE LLC
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 103 W PINE ST
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City | COLQUITT
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State | GA
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Zip | 39837-3526
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Country | US
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Telephone | 229-758-3002
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Fax | 229-758-9415
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Provider Business Mailing Address
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Address Line | 103 W PINE ST
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City | COLQUITT
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State | GA
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Zip | 39837-3526
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Country | US
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Telephone | 229-758-3002
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Fax | 229-758-9415
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | WILLIAM FRANKLIN SWOFFORD
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Credential | MD
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Telephone | 229-758-3002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 046262
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License Number State | GA
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