Colquitt Regional Pediatrics, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

COLQUITT REGIONAL PEDIATRICS, LLC

Practice address

1 Sweet Bay CT
Moultrie, GA 31768-6756

Phone

(229) 985-5437

Fax

(229) 985-0131

NPI assigned

Oct 28, 2015

Last updated

May 8, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Denise Romanowski

Title

Director

Phone

(229) 891-9559

Specialties & licenses 1

Addresses

Other identifiers 3

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1445990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525737600000",
    "number": "1154793214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1120",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317761120",
            "telephone_number": "229-985-5437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SWEET BAY CT",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686756",
            "telephone_number": "229-985-5437",
            "fax_number": "229-985-0131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLQUITT REGIONAL PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-28",
        "last_updated": "2018-05-08",
        "status": "A",
        "authorized_official_last_name": "ROMANOWSKI",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "229-891-9559"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003170656B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003170656A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "10270G0891",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Colquitt Regional Spine LLC (Sterling Group Spine Center)
• Colquitt Regional Surgery, LLC (Sterling Group Surgery)

• Pediatrics Physician in Moultrie, GA
• Providers in Moultrie, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.