| Colquitt Regional Psychiatry Llc | |
|
6 Hospital Park Moultrie GA 31768-6700 | |
| (229) 891-9443 | |
| (229) 890-7448 |
| Full Name | Colquitt Regional Psychiatry Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6 Hospital Park, Moultrie, Georgia |
| Authorized Official Name and Position | Patricia Sutherland (PROVIDER ENROLLMENT) |
| Authorized Official Contact | 2298919131 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Colquitt Regional Psychiatry Llc Po Box 2876 Moultrie GA 31776-2876 Ph: (229) 891-9131 | Colquitt Regional Psychiatry Llc 6 Hospital Park Moultrie GA 31768-6700 Ph: (229) 891-9443 |
| NPI Number | 1407459027 |
|---|---|
| Provider Enumeration Date | 11/17/2020 |
| Last Update Date | 07/28/2023 |
| Certification Date | 07/28/2023 |
| Medicare PECOS PAC ID | 4981012655 |
|---|---|
| Medicare Enrollment ID | O20210419000060 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407459027 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Henry A Eugenio |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942233911 PECOS PAC ID: 5294636098 Enrollment ID: I20040115000516 |
| Provider Name | Jaymal R. Patel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962433599 PECOS PAC ID: 3779474010 Enrollment ID: I20040324000650 |
| Provider Name | Lisa A Rudolph-watson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881627867 PECOS PAC ID: 0941293963 Enrollment ID: I20040406000711 |
| Provider Name | James D Drury |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467632851 PECOS PAC ID: 1456420264 Enrollment ID: I20080520000566 |
| Provider Name | Jessica K Purvis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790296879 PECOS PAC ID: 5395177810 Enrollment ID: I20191121000113 |
| Provider Name | Justin W Graves |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821596917 PECOS PAC ID: 9638570633 Enrollment ID: I20210629000411 |
| Provider Name | Maria Jasinskas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134391022 PECOS PAC ID: 3577621465 Enrollment ID: I20230927001096 |
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