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General NPI Number Information
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NPI Number | 1477939833
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Entity Type | Organization
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Legal Business Name | COLQUITT REGIONAL EAR NOSE & THROAT
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 3007 2ND ST SE
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City | MOULTRIE
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State | GA
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Zip | 31768-6798
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Country | US
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Telephone | 229-891-3325
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2876
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City | MOULTRIE
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State | GA
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Zip | 31776-2876
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Country | US
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Telephone | 229-891-3325
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Fax | 229-890-8702
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Authorized Official
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Title or Position | CEO
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Name | JAMES L MATNEY
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Credential |
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Telephone | 229-985-3420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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