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General NPI Number Information
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NPI Number | 1477620912
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Entity Type | Organization
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Legal Business Name | MOULTRIE CENTER FOR ADULT AND PEDIATRIC HEALTHCARE, PC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 760 26TH AVE SE
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City | MOULTRIE
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State | GA
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Zip | 31768-6799
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Country | US
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Telephone | 229-985-6700
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Fax | 229-891-2382
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Provider Business Mailing Address
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Address Line | 760 26TH AVE., SE
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City | MOULTRIE
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State | GA
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Zip | 31768-6799
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Country | US
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Telephone | 229-985-6700
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Fax | 229-891-2382
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. RHONDA R. SMITH
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Credential |
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Telephone | 229-985-6700
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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 |
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License Number State |
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