| Colquitt Regional Gastroenterology, Llc | |
|
4 Live Oak Ct Moultrie GA 31768-6783 | |
| (229) 785-2400 | |
| Not Available |
| Full Name | Colquitt Regional Gastroenterology, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4 Live Oak Ct, Moultrie, Georgia |
| Authorized Official Name and Position | Ashley Carl Mcgowan (DIRECTOR) |
| Authorized Official Contact | 2298919365 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Colquitt Regional Gastroenterology, Llc Po Box 1342 Moultrie GA 31776-1342 Ph: (229) 785-8068 | Colquitt Regional Gastroenterology, Llc 4 Live Oak Ct Moultrie GA 31768-6783 Ph: (229) 785-2400 |
| NPI Number | 1225358294 |
|---|---|
| Provider Enumeration Date | 06/01/2010 |
| Last Update Date | 07/28/2023 |
| Medicare PECOS PAC ID | 1153552724 |
|---|---|
| Medicare Enrollment ID | O20140324001845 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225358294 | NPI | - | NPPES |
| 202G700219 | Other | GA | MEDICARE GROUP PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (Georgia) | Primary |
| Provider Name | Justin A Baker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790707925 PECOS PAC ID: 5294739033 Enrollment ID: I20080429000440 |
| Provider Name | Michael J Dawson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1134153711 PECOS PAC ID: 3870785199 Enrollment ID: I20101005001034 |
| Provider Name | Lori Marie White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184277717 PECOS PAC ID: 8224367057 Enrollment ID: I20190904001945 |
| Provider Name | Jordan Boyd Rentz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780274050 PECOS PAC ID: 2163836958 Enrollment ID: I20210208001334 |
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