| Colquitt Regional Neurology, Llc | |
|
780 26th Ave Se Moultrie GA 31768-6799 | |
| (229) 502-9735 | |
| (229) 502-9733 |
| Full Name | Colquitt Regional Neurology, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 780 26th Ave Se, Moultrie, Georgia |
| Authorized Official Name and Position | Stewart Merdian (DIRECTOR) |
| Authorized Official Contact | 2298903531 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Colquitt Regional Neurology, Llc Po Box 1387 Moultrie GA 31776-1387 Ph: (229) 502-9735 | Colquitt Regional Neurology, Llc 780 26th Ave Se Moultrie GA 31768-6799 Ph: (229) 502-9735 |
| NPI Number | 1023435666 |
|---|---|
| Provider Enumeration Date | 03/20/2014 |
| Last Update Date | 07/28/2023 |
| Certification Date | 07/28/2023 |
| Medicare PECOS PAC ID | 0749408284 |
|---|---|
| Medicare Enrollment ID | O20140826001024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023435666 | NPI | - | NPPES |
| 202G704225 | Other | GA | MEDICARE GROUP PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (Georgia) | Primary |
| Provider Name | Rebecca Mobley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790072783 PECOS PAC ID: 2961671631 Enrollment ID: I20110815000404 |
| Provider Name | Kent Posey |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1689802258 PECOS PAC ID: 4385883933 Enrollment ID: I20140826002663 |
| Provider Name | Amanda D Strickland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285117630 PECOS PAC ID: 3779820360 Enrollment ID: I20190118002491 |
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